The impact of HENRY on parenting and family lifestyle: A national service evaluation of a preschool obesity prevention programme

Abstract Background In December 2020, Public Health England with NHS Test and Trace initiated a pilot study in which close contacts of people with confirmed COVID-19 were given the option to carryout lateral flow device antigen tests at home, as an alternative to self-isolation for 10–14 days. In this study, we evaluated engagement with daily testing, and assessed levels of adherence to the rules relating to behaviour following positive or negative test results. Methods We conducted a service evaluation of the pilot study, examining survey responses from a subset of those who responded to an evaluation questionnaire. We used an online cross-sectional survey offered to adult contacts of confirmed COVID-19 cases who consented to daily testing. We used a comparison group of contacts who were not offered testing and instead self-isolated. Results Acceptability of daily testing was lower among survey respondents who were not offered the option of testing and among people from ethnic minority groups. Overall, 52% of respondents reported being more likely to share details of people that they had been in contact with following a positive test result, if they knew that their contacts would be offered the option of daily testing. Only 2% reported that they would be less likely to provide details of their contacts. On the days that they were trying to self-isolate, 19% of participants reported that they left the house, with no significant group differences. Following a negative test, 13% of respondents reported that they increased their contacts, but most (58%) reported having fewer risky contacts. Conclusions Our data suggest that daily testing is potentially acceptable, may facilitate sharing contact details of close contacts among those who test positive for COVID-19, and promote adherence to self-isolation. A better understanding is needed of how to make this option more acceptable for all households. The impact of receiving a negative test on behaviour remains a risk that needs to be monitored and mitigated by appropriate messaging. Future research should examine attitudes and behaviour in a context where infection levels are lower, testing is more familiar, and restrictions on activity have been reduced.

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P134 Maintaining confidentiality in sexual health clinics; a local and national service evaluation

Sexually Transmitted Infections ◽

10.1136/sextrans-2016-052718.188 ◽

2016 ◽

Vol 92 (Suppl 1) ◽

pp. A66.2-A66

Author(s):

Rebecca Duffield ◽

Emily Clarke ◽

Mickaela Poree ◽

Tony Lamb ◽

Alan Tang ◽

...

Keyword(s):

Sexual Health ◽

Service Evaluation ◽

National Service ◽

Health Clinics ◽

Sexual Health Clinics

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AB1174 TRACKING THE EFFECTS ON A CLINICAL SERVICE OF INTRODUCING ULTRASOUND FOR DIAGNOSIS OF GIANT CELL ARTERITIS: DESIGN OF A SERVICE EVALUATION USING LEAN METHODOLOGY

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.646 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1877.2-1878

Author(s):

S. Mackie ◽

A. Barr ◽

A. Cracknell ◽

S. Farrell ◽

J. Parvin ◽

...

Keyword(s):

Lead Time ◽

Axillary Artery ◽

Care Pathway ◽

Temporal Artery ◽

Service Evaluation ◽

Significant Shift ◽

Temporal Artery Biopsy ◽

Prednisolone Dose ◽

Patient Feedback ◽

The Impact

Background:In our large, multi-site hospital, patients with suspected GCA are started promptly on high-dose prednisolone but until 2019, patients waited for temporal artery biopsy (TAB) until the GCA diagnosis could be confirmed (“GCA”) or refuted (“not-GCA”). Reports of the impact of introducing temporal and axillary artery ultrasound (TAUS) have mainly come from smaller hospitals. Agreement between TAUS and TAB has been reported by others with a Cohen’s kappa of 0.35 [1] and 0.40 [2]. We used Lean methodology to identify metrics across 5 key domains: delivery, quality, service, morale and cost.Objectives:To design metrics for a service evaluation to measure impact of introducing TAUS, and to test their feasibility of measurement within routine care.Methods:Our primary driver was time from presenting to our service to diagnostic confirmation (lead time). Pathway mapping, value stream mapping and a driver diagram identified key ideas for improvement.We chose to measure: Delivery (mean lead time for each month), Quality (proportion of patients with GCA and positive TAB/TAUS; total (cumulative) prednisolone dose in patients with not-GCA, Service (patient feedback), Morale (staff feedback) and Cost (number of patients; cost of tests per patient; overall costs). We plotted these by month on run charts and defined a significant shift as 6 consecutive monthly values below baseline median. Cohen’s kappa was calculated using GraphPad QuickCalcs.Results:Routine TAUS for suspected GCA was introduced from January 2019, alongside a multidisciplinary team monthly meeting. TAUS was done a median of 2.5 days from referral. Agreement between TAB and TAUS results was good (Table 1). The run chart showed a significant shift in our Delivery (median lead time fell from 28.7 days to 21 days after introduction of ultrasound) and both Quality metrics (proportion of GCA with positive TAB/TAUS increased from 29% to 69%; total prednisolone dose for not-GCA fell from 1.335g to 0.846g).Table 1.Concordance between temporal and axillary artery ultrasound (TAUS) and temporal artery biopsy (TAB) in scans performed through 2019. Cohen’s weighted kappa 0.59 (including equivocal results as separate category).TAUS positiveTAUS negativeTAUS equivocalTAB positive1411TAB negative5275TAB equivocal030Within Costs, average per-patient costs of TAB/TAUS declined from £1004/patient to £792/patient, but total referrals for TAB/TAUS increased from 6/month to 10/month, increasing overall costs. Staff and patient feedback (Service, Morale) revealed that further improvements to the care pathway were needed to manage the additional complexity.Conclusion:Lean methodology identified multiple metrics for evaluating the impact of TAUS on our service. Introducing TAUS improved Delivery and Quality, but measuring Costs, Morale and Service helped identify unintended consequences. Concordance between TAUS and TAB was good. We plan to continue to improve and monitor the care pathway based on our multi-stakeholder feedback.References:[1]Luqmani et al., HTA 2016[2]Mukhtyar et al., Clin Rheum 2019Disclosure of Interests:Sarah Mackie Grant/research support from: Roche (attendance of EULAR 2019; co-applicant on research grant), Consultant of: Sanofi, Roche/Chugai (monies paid to my institution not to me), Andrew Barr: None declared, Alison Cracknell: None declared, Shannon Farrell: None declared, Jimmy Parvin: None declared, Ajay Patil: None declared, Ian Simmons: None declared, Kate Smith Grant/research support from: Medical education grants from Sanofi and Biogen, Speakers bureau: Novartis, Andrea Sweeting: None declared, Max Troxler: None declared, Tara Webster: None declared, Richard Wakefield Speakers bureau: Novartis, Janssen, GE

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1117 Managing Cosmetic Surgery Complications: A Retrospective Service Evaluation

British Journal of Surgery ◽

10.1093/bjs/znab259.721 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

J Luck ◽

E Strachan ◽

B Piggott ◽

S Saour

Keyword(s):

Cosmetic Surgery ◽

Average Length ◽

Service Evaluation ◽

Surgery Complications ◽

Surgical Interventions ◽

Financial Costs ◽

Service Activity ◽

Patient Level Costing ◽

The Uk ◽

The Impact

Abstract Aim The cosmetic surgery industry continues to grow, both within the UK and internationally. There is a perception that the NHS is often left to deal with the complications of these procedures, particularly those performed abroad. This study aimed to evaluate the burden of cosmetic surgery complications on a tertiary London plastics service with an appraisal of the financial costs incurred. Method This one-year retrospective service evaluation included all emergent referrals following cosmetic surgical interventions in the UK private sector and abroad. Outpatient referrals and planned revisional procedures were excluded. Financial costs were based upon current Clinical Commissioning Group tariffs. Results In total, 14 patients were included (seven from the UK and seven from Europe or North Africa). Remote telemedicine advice was provided for six patients; eight patients required admission. All eight admissions were female with an average age of 42.6 years. The most common complication was infection (75%) with an average length of stay of 2.3 nights. These eight patients required six trips to theatre, two CT scans and 37 outpatient visits. The median tariff per patient was £1,510 (range £242 to £5,196), leading to an overall reimbursement of £16,471. The majority of these costs were generated during inpatient admissions (£12,855) with a lesser contribution from outpatient episodes (£3,616). Conclusions This project provides an overview of the impact of managing emergent complications following cosmetic surgery, both in terms of service activity and financial cost. A long-term, prospective service evaluation of both elective and emergency referrals based upon patient-level costing data is now underway.

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A cluster RCT and process evaluation evaluating the effectiveness of an optimisation intervention to promote parental engagement in a childhood obesity prevention programme: Results of the Optimising Family Engagement in HENRY (OFTEN) trial

10.21203/rs.3.rs-188964/v1 ◽

2021 ◽

Author(s):

Maria Bryant ◽

Wendy Burton ◽

Michelle Collinson ◽

Amanda Farrin ◽

Jane Nixon ◽

...

Keyword(s):

Childhood Obesity ◽

Process Evaluation ◽

Obesity Prevention ◽

Controlled Trial ◽

Cluster Randomised Controlled Trial ◽

Parental Engagement ◽

Childhood Obesity Prevention ◽

Prevention Intervention ◽

The Impact ◽

Children’S Centres

Abstract Background Low parental participation reduces the impact and sustainability of public health childhood obesity prevention programmes. Using data from a focused ethnography, we developed a multi-level, theory-based implementation optimisation intervention. The optimisation intervention aimed to support local authorities and children’s centres to adopt behaviours to promote engagement in ‘HENRY (Health Exercise Nutrition for the Really Young)’, a UK community obesity prevention intervention. Methods We evaluated the effectiveness of the optimisation intervention on programme enrolment and completion over a 12 implementation period in a cluster randomised controlled trial. We randomised 20 local government authorities (with 126 children’s centres) to HENRY plus the optimisation intervention or to HENRY alone. Primary outcomes were (1) the proportion of centres enrolling at least eight parents per programme and (2) the proportion of centres with a minimum of 75% of parents attending at least five of eight sessions per programme. Trial analyses adjusted for stratification factors (pre-randomisation implementation of HENRY, local authority size, deprivation) and allowed for cluster design. A parallel mixed-methods process evaluation used qualitative interview data and routine monitoring to explain trial results. Results Neither primary outcome differed significantly between groups; 17.8% of intervention centres and 18.0% of control centres achieved the parent enrolment target (adjusted difference -1.2%; 95%CI: -19.5%, 17.1%); 17.1% of intervention centres and 13.9% of control centres achieved the attendance target (adjusted difference 1.2%; 95%CI: -15.7%, 18.1%). Unexpectedly, the trial coincided with substantial national service restructuring, including centre closures and reduced funds. Some commissioning and management teams stopped or reduced implementation of both HENRY and the optimisation intervention due to competing demands. Thus, at follow up, HENRY programmes were delivered to approximately half the number of parents compared to baseline (n=433 vs. 881). Conclusions During a period in which services were reduced by policies outside the realm of this research, this first definitive trial found no evidence of effectiveness for an implementation optimisation intervention promoting parent engagement in an obesity prevention intervention. Trial registration: ClinicalTrials.gov Identifier: NCT02675699 registered 4th February 2016. https://clinicaltrials.gov/ct2/show/NCT02675699

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Service evaluation for services for younger people with dementia in east locality of north Wales

BJPsych Open ◽

10.1192/bjo.2021.108 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S20-S20

Author(s):

Asha Dhandapani ◽

Sathyan Soundararajan ◽

Sharmi Bhattacharyya

Keyword(s):

Time Frame ◽

Service Evaluation ◽

Young Onset ◽

People With Dementia ◽

North Wales ◽

Number Of Patients ◽

Time To Diagnosis ◽

Working Age ◽

The Impact ◽

Timely Referral

AimsTo evaluate Young-onset dementia (YOD) services in terms of referral, its appropriateness, time to diagnosis and other criteria as per protocol that we have adapted.MethodCase notes of those under 65 referred to Memory service for cognitive assessment between July 2017 and June 2018 were retrospectively reviewed to look at the time to diagnosis, appropriate referrals, post-diagnostic support, etc.ResultCompared to the previous evaluation, the number of patients referred to had increased from 47–48/ year earlier to 63/year. Only 1/3 were appropriate referral over the 10-year period whereas between 2017 and 2018 more than half were appropriate referrals. More than half of them were seen within 12 weeks of referral (35/63 available). Only 132/252 were diagnosed as having some form of dementia in the previous evaluation which was about 13 cases of YOD a year. In contrast, in our new evaluation 19 patients were diagnosed with some form of dementia. Inappropriate referrals had reduced by more than 50%. Appropriateness and timely referral had improved in this time frame.ConclusionDementia is considered ‘young onset’ when it affects people under 65 years of age. It is also referred to as ‘early onset’ or ‘working age’ dementia. However, this is an arbitrary age distinction that is becoming less relevant as increasingly services are realigned to focus on the person and the impact of the condition, not the age. Teaching sessions to educate primary & secondary care clinicians on appropriateness and timely referrals have helped in improving the care for patients with YOD. Services need to be developed further to be able to diagnose & support those with YOD. Repeat evaluations every year would help to inform improvement in quality & appropriateness of referrals.

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The impact of first COVID-19 peak on patient referrals to Liaison Psychiatry Service and staff perception about service provision in Birmingham and Solihull Mental Health Trust Birmingham - a service evaluation project

BJPsych Open ◽

10.1192/bjo.2021.865 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S329-S329

Author(s):

Saima Jehanzeb ◽

Muhammad Suleman ◽

Ella Tumelty ◽

Joanne Okusanya ◽

Laxsan Karunanithy ◽

...

Keyword(s):

Mental Health ◽

Focus Groups ◽

Quantitative Methods ◽

Service Evaluation ◽

Psychotic Symptoms ◽

Healthcare Provision ◽

Liaison Psychiatry ◽

Clinical Databases ◽

The Impact ◽

Health Trust

AimsBased on recommendations from the Royal College of Psychiatrists, this project aimed to evaluate the impact of the first peak of the COVID-19 pandemic on referral patterns to the Queen Elizabeth Hospital Birmingham (QEHB) Liaison Psychiatry (LP) service. Additionally, we aimed to explore staff experiences in LP services across Birmingham and Solihull Mental Health Trust (BSMHFT) in order to generate Trust recommendations promoting optimal healthcare provision amidst the on-going pandemic.MethodA mixed method service evaluation was conducted using quantitative and qualitative analysis. Quantitative methods involved reviewing referrals made to the QEHB LP service from March to June 2020, compared with the equivalent time period in 2019. Data were retrospectively extracted from the electronic clinical databases RIO and PICS, and subsequently analysed using Microsoft Office. The number of, and reasons for referrals to LP were identified, whilst focus groups were conducted to explore the subjective experiences of staff working across BSMHFT LP services.ResultBetween 1st March and 30th June 2020, 984 referrals were made to the QEHB LP service, compared to 1020 referrals in 2019, representing a 3.5% reduction. From 2019 to 2020, referrals due to psychotic symptoms and deliberate self-harm rose by 12.8% and 14.1% respectively, whilst referrals for drug and alcohol-related causes reduced by 28.3%. A significant increase (150%) in referrals for medication or management advice was seen. Focus groups indicated that staff perceived an initial reduction in number of referrals, but an increase in the acuity of patient presentations.Staff reported anxiety around contracting and transmitting SARS-Cov-2, exacerbated by uncertainty around patients’ COVID-19 status. In QEHB, sixty-five of the 984 referrals (7%) had a positive SARS-Cov-2 PCR swab, with the remaining 919 referrals being either negative (68%) or unknown (25%). Ninety-six percent of consultations were conducted face-to-face in QEHB. There were conflicting views amongst staff regarding whether more consultations could have been conducted remotely. Furthermore, varying perceptions of support and communication from both the physical and mental health trust were reported.ConclusionQuantitative data indicates that COVID-19 impacted LP healthcare provision in BSMHFT. Whilst referral numbers remained similar between the equivalent period in 2019 and 2020, a change in the nature of referrals to LP at QEHB was seen. This was corroborated by qualitative data which highlighted a perceived change in acuity of referrals. These findings have been disseminated across the Trust and subsequent recommendations are being implemented during the on-going pandemic.

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