Health and social care delivery research最新文献

{"title":"Emergency Medical Services Streaming Enabled Evaluation In Trauma: The SEE-IT Feasibility RCT.","authors":"Cath Taylor, Lucie Ollis, Richard Lyon, Julia Williams, Simon S Skene, Kate Bennett, Scott Munro, Craig Mortimer, Matthew Glover, Janet Holah, Jill Maben, Carin Magnusson, Rachael Cooke, Heather Gage, Mark Cropley","doi":"10.3310/EUFS2314","DOIUrl":"10.3310/EUFS2314","url":null,"abstract":"<p><strong>Background: </strong>The use of bystander video livestreaming from scene in emergency medical services is becoming increasingly common to inform decisions about the resources and support required. Possible benefits include clinical and financial gains, but evidence is sparse. We aimed to investigate the feasibility of conducting a definitive randomised controlled trial of its use in major trauma incidents.</p><p><strong>Objectives: </strong>To obtain data required to design a subsequent randomised controlled trial. To test trial processes. To embed a process evaluation.</p><p><strong>Design: </strong>A feasibility randomised controlled trial with embedded process and economic evaluations where working shifts (<i>n</i> = 62) in 6 trial weeks were randomised 1 : 1 to video livestreaming or standard care only; and two observational substudies: (1) assessment of acceptability in a diverse inner-city emergency medical service that routinely uses video livestreaming; and (2) assessment of staff well-being in an emergency medical service that does not use livestreaming (for comparison to the trial site). Qualitative data collection included observations (286 hours) and interviews with staff (<i>n</i> = 25) and bystander callers (<i>n</i> = 2).</p><p><strong>Setting: </strong>A pre-hospital emergency medical service in South-East England, with follow-up in associated major trauma centres and trauma units; substudies in (1) London and (2) East of England emergency medical services.</p><p><strong>Participants: </strong>(1) Patients involved in trauma incidents (<i>n</i> = 269); (2) bystander callers (<i>n</i> = 11); and (3) ambulance service staff (<i>n</i> = 67).</p><p><strong>Intervention: </strong>Video livestreaming using GoodSAM's Instant-On-Scene.</p><p><strong>Main outcome measures: </strong>Progression to a definitive randomised controlled trial based on four pre-defined criteria and consideration of qualitative data: (1) ≥ 70% bystanders with smartphones agreeing and able to activate livestreaming; (2) ≥ 50% requests to activate livestreaming resulting in footage being viewed; (3) helicopter emergency medical services stand-down rate reducing by ≥ 10% due to livestreaming; and (4) no evidence of psychological harm to bystanders or staff caused by livestreaming.</p><p><strong>Results: </strong>Sixty-two shifts were randomised, contributing 240 eligible incidents (132 control; 108 intervention). In a further three shifts, we randomised by individual call, which contributed four eligible incidents (two control; two intervention), thereby totalling 244 incidents involving 269 patients. Video livestreaming was successful in 53 incidents in the intervention arm. Patient recruitment (to access medical records to assess appropriateness of dispatch) and bystander recruitment (to measure potential harm) were both low (58/269, 22% of patients, 4/244, 2% of bystanders). Two progression criteria were met: (1) 86% of bystanders with smartphones agree","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":" ","pages":"1-38"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188716","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":"Opportunities and practices supporting responsive health care for forced migrants: lessons from transnational practice and a mixed-methods systematic review.","authors":"Amy Robinson, Protus Musotsi, Ziaur Rahman A Khan, Laura Nellums, Bayan Faiq, Kofi Broadhurst, Gisela Renolds, Michael Pritchard, Andrew Smith","doi":"10.3310/MRWK3419","DOIUrl":"https://doi.org/10.3310/MRWK3419","url":null,"abstract":"<p><strong>Background: </strong>For those displaced across borders, significant adversity before, during and after displacement journeys, including attitudes and structures in countries of transit and arrival, contributes to considerable risk of poor physical and mental health, and poor and exclusionary experiences of health care.</p><p><strong>Objectives: </strong>We aimed to understand the opportunities and practices that can support better healthcare responses for forced migrants.</p><p><strong>Design: </strong>We integrated (1) local stakeholder perspectives, from workshops and dialogue; (2) evidence and knowledge from a mixed-methods systematic review; and (3) learning from five case examples from current international practice.</p><p><strong>Review methods and data sources: </strong>We ran database searches (American Psychological Association PsycINFO, EMBASE, the Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, MEDLINE, National Institute for Health and Care Research Journals Library) in February 2022, searched relevant agency websites and conducted backward and forward citation searches, extracted data, assessed methodological quality and integrated qualitative and quantitative findings.</p><p><strong>Case examples: </strong>We studied three services in the UK, one in Belgium and one in Australia, conducting semistructured interviews with providers, collaborators and service users, and making site visits and observations if possible.</p><p><strong>Results: </strong>The review identified 108 studies. We identified six domains of impact: (1) benefit from and creation of community, including linkages with formal (health) services; (2) the formation of networks of care that included traditional and non-traditional providers; (3) proactive engagement, including conducting care in familiar spaces; (4) considered communication; (5) informed providers and enhanced attitudes; and (6) a right to knowledge (respecting the need of new arrivals for information, knowledge and confidence in local systems). The case examples drew attention to the benefits of a willingness to innovate and work outside existing structures, 'micro-flexibility' in interactions with patients, and the creation of safe spaces to encourage trust in providers. Other positive behaviours included engaging in intercultural exchange, facilitating the connection of people with their cultural sphere (e.g. nationality, language) and a reflexive attitude to the individual and their broader circumstances. Social and political structures can diminish these efforts.</p><p><strong>Limitations: </strong>Review: wide heterogeneity in study characteristics presented challenges in drawing clear associations from the data. Case examples: we engaged only a small numbers of service users and only with service users from some services.</p><p><strong>Conclusions: </strong>We found that environments that enable good health and enable people to l","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"13 13","pages":"1-182"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144049064","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 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":"Implementing routine assessment of perinatal anxiety: case studies.","authors":"Andrea Sinesi, Georgina Constantinou, Cassandra Yuill, Rose Meades, Helen Cheyne, Margaret Maxwell, Catherine Best, Susan Ayers, Judy Shakespeare, Fiona Alderdice, Julie Jomeen, Grace Howard","doi":"10.3310/WWMD9982","DOIUrl":"10.3310/WWMD9982","url":null,"abstract":"<p><strong>Background: </strong>During pregnancy and the first postnatal year, a substantial proportion of women experience perinatal anxiety, which is associated with increased risk of adverse birth, maternal and child development outcomes. Identification of perinatal anxiety is recommended in various countries, but there is a lack of consensus on the most effective, acceptable and feasible measure to use. The Methods of Assessing Perinatal Anxiety study previously found the Stirling Antenatal Anxiety Scale to be diagnostically accurate and acceptable to women.</p><p><strong>Objectives: </strong>This study aimed to determine the acceptability and feasibility of implementing new assessment of perinatal anxiety in healthcare services.</p><p><strong>Design and methods: </strong>Implementation case studies of perinatal anxiety assessment using the Stirling Antenatal Anxiety Scale in three National Health Service sites in the United Kingdom. Semistructured interviews and focus groups were conducted before and after implementation with healthcare professionals working in maternity, primary care and psychological services that had contact with perinatal women. Preimplementation data collection was used to develop an implementation and training strategy for each site. Interviews and focus groups were conducted with the same participants post implementation. Data were analysed using framework analysis and a combined inductive-deductive approach.</p><p><strong>Setting and participants: </strong>Two National Health Service trusts in England and one National Health Service health board in Scotland. Participants were healthcare professionals, including midwives, health visitors, clinical psychologists and mental health nurses, who used the scale during the implementation period. Other stakeholders such as service managers and team leads were also interviewed. Sites were selected to represent different types of service and pathways of care. The sample comprised 37 participants at preimplementation and 27 at the postimplementation stage.</p><p><strong>Intervention: </strong>Implementation of new assessment of perinatal anxiety in National Health Service services.</p><p><strong>Results: </strong>At the English sites, one focus group and two interviews were conducted at site E1, and five interviews at site E2. At the Scottish site, two focus groups and six interviews were conducted. Evaluation findings were categorised into 5 themes (experience of change in practice, barriers/facilitators to implementation, acceptability, feasibility, improvements to implementation strategy) with 16 subthemes. The experience of introducing a new assessment tool in clinical practice was generally seen as positive, with the scale enabling more focused conversations with women about their symptoms and different types of anxiety. Potential barriers to conducting assessments included women not having English as first language and stigma towards anxiety in some cultures. The scale ove","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":" ","pages":"1-17"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144145351","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}