Engagement

2017 ◽  
Author(s):  
Tom Burns ◽  
Mike Firn
Keyword(s):  
Case Studies ◽  
Social Care ◽  
Missed Appointments ◽  
Related Activity ◽  
Health And Social Care ◽  
Patient Reported ◽  
Service Perspective

Engagement is defined and a classification of engagement-related activity presented, underlining the centrality of individual and team relationships in delivering health and social care to individuals. Case studies provide practical illustration of differing approaches in the hierarchy of engaging individuals in treatment, from mutually constructive strategies to more restrictive tactics for people who avoid services. Throughout, the patient and service perspective is compared, for example, when does conscientious follow-up become perceived as harassment? Critique and evidence from research and patient testimony is provided. The value of engagement measures are discussed, including patient reported attachment and proxy measures of missed appointments and dropout.

scholarly journals Exploring, measuring and enhancing the coproduction of health and well-being at the national, regional and local levels through comparative case studies in Sweden and England: the ‘Samskapa’ research programme protocol

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e029723 ◽  
Author(s):  
Sofia Kjellström ◽  
Kristina Areskoug-Josefsson ◽  
Boel Andersson Gäre ◽  
Ann-Christine Andersson ◽  
Marlene Ockander ◽  
...  
Keyword(s):  
Case Studies ◽  
Quantitative Methods ◽  
Social Care ◽  
Knowledge Exchange ◽  
Research Programme ◽  
Well Being ◽  
Explanatory Models ◽  
Longitudinal Case Study ◽  
Health And Social Care ◽  
Health And Well Being

IntroductionCocreation, coproduction and codesign are advocated as effective ways of involving citizens in the design, management, provision and evaluation of health and social care services. Although numerous case studies describe the nature and level of coproduction in individual projects, there remain three significant gaps in the evidence base: (1) measures of coproduction processes and their outcomes, (2) mechanisms that enable inclusivity and reciprocity and (3) management systems and styles. By focusing on these issues, we aim to explore, enhance and measure the value of coproduction for improving the health and well-being of citizens.Methods and analysisNine ongoing coproduction projects form the core of an interactive research programme (‘Samskapa’) during a 6-year period (2019–2024). Six of these will take place in Sweden and three will be undertaken in England to enable knowledge exchange and cross-cultural comparison. The programme has a longitudinal case study design using both qualitative and quantitative methods. Cross-case analysis and a sensemaking process will generate relevant lessons both for those participating in the projects and researchers. Based on the findings, we will develop explanatory models and other outputs to increase the sustained value (and values) of future coproduction initiatives in these sectors.Ethics and disseminationAll necessary ethical approvals will be obtained from the regional Ethical Board in Sweden and from relevant authorities in England. All data and personal data will be handled in accordance with General Data Protection Regulations. Given the interactive nature of the research programme, knowledge dissemination to participants and stakeholders in the nine projects will be ongoing throughout the 6 years. External workshops—facilitated in collaboration with participating case studies and citizens—both during and at the end of the programme will provide an additional dissemination mechanism and involve health and social care practitioners, policymakers and third-sector organisations.

scholarly journals The effectiveness of the Older prisoner Health and Social Care Assessment and Plan (OHSCAP): a randomised controlled trial

2017 ◽  
Vol 5 (31) ◽  
pp. 1-186 ◽  
Author(s):  
Katrina Forsyth ◽  
Laura Archer-Power ◽  
Jane Senior ◽  
Rachel Meacock ◽  
Roger Webb ◽  
...  
Keyword(s):  
Social Care ◽  
Unit Cost ◽  
Well Being ◽  
Functional Health ◽  
Care Needs ◽  
Care Plans ◽  
Older Prisoners ◽  
Care Assessment ◽  
Health And Social Care

Background Older people are the fastest-growing group in prisons in England and Wales and have complex health and social care needs that often remain unmet. Objectives (1) Evaluate the efficacy of the Older prisoner Health and Social Care Assessment and Plan (OHSCAP) in improving (i) the ability to meet older male prisoners’ health and social care needs, (ii) health-related quality of life (HRQoL), (iii) depressive symptoms and (iv) functional health and well-being and activities of daily living; (2) assess the quality of care plans produced; (3) explore the experiences of older prisoners receiving, and staff conducting, the OHSCAP; and (4) evaluate the cost-effectiveness of the OHSCAP compared with treatment as usual (TAU). Design Multicentre, parallel-group randomised controlled trial (RCT) with follow-up at 3 months, with a nested qualitative study and quality audit of care plans (n = 150, 68%). Setting Ten English prisons. Participants Four hundred and ninety-seven newly arrived male prisoners aged ≥ 50 years with a discharge date at least 3 months from recruitment. A total of 14 prisoners and 11 staff participated in qualitative interviews. Intervention Randomisation to OHSCAP or TAU. The OHSCAP group had health and social needs assessed by a trained health-care worker or prison officer. Care plans were devised and subsequent actions included professional support and appropriate referrals. Main outcome measures Primary outcome measure – mean number of unmet health and social care needs as measured by the Camberwell Assessment of Need – Short Forensic Version. Secondary outcome measures – measures of functional health and well-being, depressive symptoms and HRQoL. A health economic evaluation was undertaken using service contact between baseline and follow-up and appropriate unit cost information. Results A total of 497 prisoners were recruited (248 to OHSCAP and 249 to TAU). The 404 completed follow-ups were split evenly between the trial arms. No significant differences were observed between the intervention and TAU groups in relation to the primary outcome measure. The OHSCAP did not demonstrate convincing benefits in HRQoL over TAU, and there were no significant differences in relation to costs. Audit and qualitative data suggest that the intervention was not implemented as planned. Limitations As a result of the limited follow-up period, potential long-term gains of the intervention were not measured. Some of the standardised tools had limited applicability in prison settings. Cost-effectiveness data were limited by unavailability of relevant unit cost data. Conclusions The OHSCAP failed in its primary objective but, fundamentally, was not implemented as planned. This appears to have been attributable, in some part, to wider difficulties currently affecting the prison landscape, including reduced levels of staffing, the loss of specialist support roles for such initiatives and increased prevalence of regime disruption. Future work Partnership working and information sharing across disciplines within prison settings require improvement. Research should explore the potential involvement of other prisoners and third-sector organisations in identifying and addressing older prisoners’ health and social care needs to better match community provision. Further examination should be undertaken of how the prison regime and system affects the well-being of older prisoners. Future prison-based RCTs should carefully balance the fidelity of initiatives being evaluated and testing in a ‘real-life’ setting. Trial registration Current Controlled Trials ISRCTN11841493. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 5, No. 31. See the NIHR Journals Library website for further project information.

scholarly journals Synthesis for health services and policy: case studies in the scoping of reviews

2021 ◽  
Vol 9 (15) ◽  
pp. 1-84
Author(s):  
Rob Anderson ◽  
Andrew Booth ◽  
Alison Eastwood ◽  
Mark Rodgers ◽  
Liz Shaw ◽  
...  
Keyword(s):  
Health Services ◽  
Case Studies ◽  
Systematic Reviews ◽  
Information Exchange ◽  
Social Care ◽  
Evidence Synthesis ◽  
Synthesis Methods ◽  
Health And Social Care ◽  
Review Team ◽  
The University

Background For systematic reviews to be rigorous, deliverable and useful, they need a well-defined review question. Scoping for a review also requires the specification of clear inclusion criteria and planned synthesis methods. Guidance is lacking on how to develop these, especially in the context of undertaking rapid and responsive systematic reviews to inform health services and health policy. Objective This report describes and discusses the experiences of review scoping of three commissioned research centres that conducted evidence syntheses to inform health and social care organisation, delivery and policy in the UK, between 2017 and 2020. Data sources Sources included researcher recollection, project meeting minutes, e-mail correspondence with stakeholders and scoping searches, from allocation of a review topic through to review protocol agreement. Methods We produced eight descriptive case studies of selected reviews from the three teams. From case studies, we identified key issues that shape the processes of scoping and question formulation for evidence synthesis. The issues were then discussed and lessons drawn. Findings Across the eight diverse case studies, we identified 14 recurrent issues that were important in shaping the scoping processes and formulating a review’s questions. There were ‘consultative issues’ that related to securing input from review commissioners, policy customers, experts, patients and other stakeholders. These included managing and deciding priorities, reconciling different priorities/perspectives, achieving buy-in and engagement, educating the end-user about synthesis processes and products, and managing stakeholder expectations. There were ‘interface issues’ that related to the interaction between the review team and potential review users. These included identifying the niche/gap and optimising value, assuring and balancing rigour/reliability/relevance, and assuring the transferability/applicability of study evidence to specific policy/service user contexts. There were also ‘technical issues’ that were associated with the methods and conduct of the review. These were choosing the method(s) of synthesis, balancing fixed and fluid review questions/components/definitions, taking stock of what research already exists, mapping versus scoping versus reviewing, scoping/relevance as a continuous process and not just an initial stage, and calibrating general compared with specific and broad compared with deep coverage of topics. Limitations As a retrospective joint reflection by review teams on their experiences of scoping processes, this report is not based on prospectively collected research data. In addition, our evaluations were not externally validated by, for example, policy and service evidence users or patients and the public. Conclusions We have summarised our reflections on scoping from this programme of reviews as 14 common issues and 28 practical ‘lessons learned’. Effective scoping of rapid, responsive reviews extends beyond information exchange and technical procedures for specifying a ‘gap’ in the evidence. These considerations work alongside social processes, in particular the building of relationships and shared understanding between reviewers, research commissioners and potential review users that may be reflective of consultancy, negotiation and co-production models of research and information use. Funding This report has been based on work commissioned by the National Institute for Health Research (NIHR) Health Services and Delivery Research (HSDR) programme as three university-based evidence synthesis centres to inform the organisation, delivery and commissioning of health and social care; at the University of Exeter (NIHR 16/47/22), the University of Sheffield (NIHR 16/47/17) and the University of York (NIHR 16/47/11). This report was commissioned by the NIHR HSDR programme as a review project (NIHR132708) within the NIHR HSDR programme. This project was funded by the NIHR HSDR programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 15. See the NIHR Journals Library website for further project information.

Integrating health and care in the 21st century workforce

2019 ◽  
Vol 27 (2) ◽  
pp. 100-110 ◽  
Author(s):  
Matt Aiello ◽  
Julian D. Mellor
Keyword(s):  
Health Education ◽  
Case Studies ◽  
Workforce Development ◽  
Professional Learning ◽  
Social Care ◽  
Workforce Planning ◽  
Project Work ◽  
Physical And Mental Health ◽  
Content Type ◽  
Health And Social Care

Purpose The NHS needs to adapt as never before to maintain and plan for an integrated and sustainable multi-professional workforce, spanning all health and care sectors. This cannot happen without system leaders embracing workforce transformation at scale and enabling system-wide collaboration and support for multi-professional learning and role development. “By learning together, we learn how to work together”. The paper aims to discuss these issues. Design/methodology/approach The case studies included in this paper provide evidence of the ability of NHS systems to adopt integrated workforce models at scale. The case studies were chosen to demonstrate how system-wide change is possible, but still requires a partnership approach to innovation, strategic workforce planning and commissioner support for new models of care. Findings With partnership working between arm’s length bodies, commissioners, educators and workforce planners, the NHS is more than capable of generating a transformed workforce; a workforce able to continue providing safe, effective and joined-up person-centred care. Research limitations/implications The focus of this paper is integrated workforce development undertaken by Health Education England from 2017 to the date of drafting. The case studies within this paper relate to England only and are a cross-section chosen by the authors as a representative of Health Education England activity. Practical implications The NHS needs to find ways to use the wider health and care workforce to manage an ever-increasing and diverse patient population. Silo working, traditional models of workforce planning and commissioning no longer provide an appropriate response to increasing patient need and complexity. Social implications The evolution of the NHS into a joined-up, integrated health and social care workforce is essential to meet the aspirations of national policy and local workforce need – to centre care holistically on the needs of patients and populations and blur the boundaries between primary and secondary care; health and social care; physical and mental health. Originality/value This paper contains Health Education England project work and outcomes which are original and as yet unpublished.

Evaluating Patients for Elective Outpatient Foot and Ankle Surgery: Insurance as a Predictor of Patient Outcomes

2019 ◽  
Vol 12 (6) ◽  
pp. 522-529
Author(s):  
Wajeeh Bakhsh ◽  
Sean Childs ◽  
Irvin Oh ◽  
Sam Flemister ◽  
Judy Baumhauer ◽  
...  
Keyword(s):  
Patient Selection ◽  
Patient Reported Outcomes ◽  
Elective Surgery ◽  
Pain Patient ◽  
Trauma Patients ◽  
Foot And Ankle ◽  
Missed Appointments ◽  
Ankle Surgery ◽  
Patient Reported

Background. Elective surgical procedures necessitate careful patient selection. Insurance level has been associated with postoperative outcomes in trauma patients. This study evaluates the relationship insurance level has with outcomes from elective foot and ankle surgery. Methods. Retrospective chart review was performed on patients who underwent elective surgery at a single center with 1-year follow-up. Patients were classified by insurance: under-/uninsured (Medicaid, Option plans) versus fully insured. Outcomes included narcotic refills, patient-reported outcomes (PROMIS) of pain, function, and mood, and compliance with follow-up visits. Statistical analysis involved mean comparison and multivariate regression modeling, with significance P < .05. Results. Cohort groups included 220 insured and 47 under-/uninsured. Outcomes between the insured and under-/uninsured groups differed significantly in narcotic refills (0.72 vs 1.74 respectively, P < .01), missed appointments (0.13 vs 0.62, P < .01), and PROMIS results (pain 54.5 vs 60.2; function 44.3 vs 39.5; mood 44.6 vs 51.3; P < .01). The change in PROMIS scores from preoperative to 1-year postoperative were different in pain (−7.3 vs −2.5, P = .03) and function (+6.3 vs +1.3, P = .04). Regression results confirm insurance as a significant factor (coefficient 0.27, P < .01). Conclusion. These results establish that under-/uninsured patients have worse pain, patient-reported outcomes, and functional outcomes after elective foot and ankle surgery, which may inform patient selection. Levels of Evidence: Level III: Retrospective cohort study

scholarly journals P67 Risk factors for musculoskeletal pain amongst health and social care workers in the UK: results from the Health and Employment After Fifty (HEAF) study

Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_2) ◽  
Author(s):  
Stefania D'Angelo ◽  
Georgia Ntani ◽  
Holly Syddall ◽  
E C Harris ◽  
Cathy Linaker ◽  
...  
Keyword(s):  
Risk Factors ◽  
Social Care ◽  
Demographic Variables ◽  
Low Back ◽  
Care Workers ◽  
Health And Social Care ◽  
Second Year ◽  
The Uk ◽  
Site Pain

Abstract Background Musculoskeletal disorders are one of the main causes of sickness absence in the UK and their prevalence is likely to increase in workers, with the rise of state pension age. Previous research has shown that these conditions are common among health and social care workers. Therefore, we aimed to describe the prevalence of musculoskeletal pain among health and social care workers and to explore personal and occupational risk factors for pain at specific anatomical sites and for multi-site pain. Methods We used data from the second year of follow up of the Health and Employment After Fifty (HEAF) study, a cohort study of 8,134 adults aged 50-64, recruited through 24 English general practices. Health and social care workers, identified through the Standard Occupational Classification 2010, were the focus of this cross-sectional analysis. The outcome under investigation was self-reported pain lasting more than a day in the past month, at one or more of eight anatomical sites: neck, low back, mid-back, shoulder, elbow, wrist/hand, knee, foot/ankle. Socio-demographic variables, self-reported health measures, psychosocial work factors (job dissatisfaction, lack of appreciation, lack of support) and occupational activities (kneeling or squatting for more than 1 hr/day, standing for most of the day) were ascertained through postal questionnaire, and associations with pain at specific anatomical sites and multi-site (≥2 anatomical sites) pain were explored with logistic regression, firstly adjusted for age and sex and then adjusted for additional confounders. Results A total of 282 participants were working in health and social care at second year follow up. Mean age was 59 years and 90% of them were women. Of these workers, n = 199 (71%) reported pain in at least one site, while n = 147 (52%) reported multi-site pain. The most reported anatomical sites with pain were knee and low back, with a prevalence of 39% and 34% respectively. Significant risk factors for knee pain were poor self-rated health (OR = 4.2; 95%CI 2.1 to 8.2) and being exposed to kneeling for longer than an hour/day at work (OR = 2.0; 95%CI 1.2 to 3.4). Similar results were found for low back pain, while for multi-site pain mental exhaustion also appeared to have an effect. None of the socio-demographic variables or psychosocial work factors influenced the outcomes. Conclusion In a sample of health and social care workers in the UK, the prevalence of low back, neck and multi-site pain is high. The common risk factors were being exposed to kneeling at work and reporting poor/fair health. Disclosures S. D'Angelo: None. G. Ntani: None. H. Syddall: None. E.C. Harris: None. C. Linaker: None. M. Stevens: None. K. Walker-Bone: None.

scholarly journals Assessing the impact of care farms on quality of life and offending: a pilot study among probation service users in England

BMJ Open ◽  
2018 ◽  
Vol 8 (3) ◽  
pp. e019296 ◽  
Author(s):  
Helen Elsey ◽  
Tracey Farragher ◽  
Sandy Tubeuf ◽  
Rachel Bragg ◽  
Marjolein Elings ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Pilot Study ◽  
Social Care ◽  
Recruitment And Retention ◽  
Health And Social Care ◽  
Probation Service ◽  
Assess Quality ◽  
The Impact

ObjectivesTo assess the feasibility of conducting a cost-effectiveness study of using care farms (CFs) to improve quality of life and reduce reoffending among offenders undertaking community orders (COs). To pilot questionnaires to assess quality of life, connection to nature, lifestyle behaviours, health and social-care use. To assess recruitment and retention at 6 months and feasibility of data linkage to Police National Computer (PNC) reconvictions data and data held by probation services.DesignPilot study using questionnaires to assess quality of life, individually linked to police and probation data.SettingThe pilot study was conducted in three probation service regions in England. Each site included a CF and at least one comparator CO project. CFs are working farms used with a range of clients, including offenders, for therapeutic purposes. The three CFs included one aquaponics and horticulture social enterprise, a religious charity focusing on horticulture and a family-run cattle farm. Comparator projects included sorting secondhand clothes and activities to address alcohol misuse and anger management.ParticipantsWe recruited 134 adults (over 18) serving COs in England, 29% female.Results52% of participants completed follow-up questionnaires. Privatisation of UK probation trusts in 2014 negatively impacted on recruitment and retention. Linkage to PNC data was a more successful means of follow-up, with 90% consenting to access their probation and PNC data. Collection of health and social-care costs and quality-adjusted life year derivation were feasible. Propensity score adjustment provided a viable comparison method despite differences between comparators. We found worse health and higher reoffending risk among CF participants due to allocation of challenging offenders to CFs, making risk of reoffending a confounder.ConclusionsRecruitment would be feasible in a more stable probation environment. Follow-up was challenging; however, assessing reconvictions from PNC data is feasible and a potential primary outcome for future studies.

scholarly journals Adaptation to extreme weather events in complex health and social care systems: The example of older people’s services in England

2017 ◽  
Vol 36 (1) ◽  
pp. 67-91 ◽  
Author(s):  
Sarah Curtis ◽  
Katie Oven ◽  
Jonathan Wistow ◽  
Christine Dunn ◽  
Lena Dominelli
Keyword(s):  
Case Studies ◽  
Complexity Theory ◽  
Social Care ◽  
National Policy ◽  
Extreme Weather ◽  
Extreme Weather Events ◽  
Weather Events ◽  
Local Case ◽  
Health And Social Care ◽  
Care Systems

Our findings contribute to a growing international literature on how conceptual models from complexity theory may be relevant to inform planning in health and social care systems, helping to adapt and improve preparedness and resilience to extreme weather events. We focus on findings from two case studies in England and their relationship to national policy for adaptation. Complexity theory helped to frame strategies for planning for events that are emergent and unpredictable. We find from our case studies that, in spite of the uncertainty involved, some ‘principles’ derived from parts of the literature on complexity theory may provide a helpful framework for the development of more robust preparedness strategies in the health and social care sector. By viewing health and social care as a ‘system of systems’, adaptation planning recognises the interrelationships of built, institutional and social infrastructures. The idea of local systems, with variable, path-dependent attributes, which are partially closed, but permeable to other parts of the wider network, leads to an actionable model of adaptation which emphasises the potential value of local self-organisation, but also underlines the importance of co-evolution across the wider system and the vital role of national initiatives and support for adaptation strategies. The value of sharing experience from local case studies across the national system, as well as among local partners, is very apparent in the experience reported here.

scholarly journals The impacts of GP federations in England on practices and on health and social care interfaces: four case studies

2020 ◽  
Vol 8 (11) ◽  
pp. 1-118
Author(s):  
Ruth McDonald ◽  
Lisa Riste ◽  
Simon Bailey ◽  
Fay Bradley ◽  
Jonathan Hammond ◽  
...  
Keyword(s):  
Health Services ◽  
Case Studies ◽  
Quantitative Methods ◽  
Social Care ◽  
Research Programme ◽  
Central Authority ◽  
Cross Sectional ◽  
Health And Social Care ◽  
General Practices ◽  
Future Work

Background General practices have begun working collaboratively in general practitioner federations, which vary in scope, geographical reach and organisational form. Objectives The aim was to assess how federating affects practice processes, workforce, innovations in practices and the interface with health and social care stakeholders. Design This was a structured cross-sectional comparison of four case studies, using observation of meetings, interviews and analysis of documents. We combined inductive analysis with literature on ‘meta-organisations’ and networks to provide a theoretically informed analysis. Results All federations were ‘bottom-up’ voluntary membership organisations but with formal central authority structures. Practice processes were affected substantially in only one site. In this site, practices accepted the rules imposed by federation arrangements in a context of voluntary participation. Federating helped ease workforce pressures in two sites. Progress regarding innovations in practice and working with health and social care stakeholders was slower than federations anticipated. The approach of each federation central authority in terms of the extent to which it (1) sought to exercise control over member practices and (2) was engaged in ‘system proactivity’ (i.e. the degree of proactivity in working across a broader spatial and temporal context) was important in explaining variations in progress towards stated aims. We developed a typology to reflect the different approaches and found that an approach consisting of high levels of both top-down control and system proactivity was effective. One site adopted this ‘authoritative’ approach. In another site, rather than creating expectations of practices, the focus was on supporting them by attempting to solve the immediate problems they faced. This ‘indulgent’ approach was more effective than the approach used in the other two sites. These had a more distant ‘neglectful’ relationship with practices, characterised by low levels of both control over members and system proactivity. Other key factors explaining progress (or lack thereof) were competition between federations (if any), relationship with the Clinical Commissioning Group, money, history, leadership and management issues, size and geography; these interacted in a dynamic way. In the context of a tight deadline and fixed targets, federations were able to respond to the requirements to provide additional services as part of NHS Improving Access to General Practice policy in a way that would not have been possible in the absence of federations. However, this added to pressures faced by busy clinicians and managers. Limitations The focus was on only four sites; therefore, any federations that were more active than those federations in these four sites will have been excluded. In addition, although patients were interviewed, because most were unaware of federations, they generally had little to say on the subject. Conclusions General practices working collaboratively can produce benefits, but this takes time and effort. The approach of the federation central authority (authoritative, indulgent or neglectful) was hugely influential in affecting processes and outcomes. However, progress was generally slower than anticipated, and negligible in one case. Future work Future work would benefit from multimethod designs, which provide in-depth, longitudinal, qualitative and quantitative methods, to shed light on processes and impacts. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 11. See the NIHR Journals Library website for further project information.

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