096 The self-management of long-term conditions in the online era: an exploration of osteoarthritis-related videos on YouTube from 2017 in the United Kingdom

BACKGROUND Since the introduction of digital health technologies in National Health Service (NHS), health professionals are starting to use email, text, and other digital methods to consult with their patients in a timely manner. There is lack of evidence regarding the economic impact of digital consulting in the United Kingdom (UK) NHS. OBJECTIVE This study aimed to estimate the direct costs associated with digital consulting as an adjunct to routine care at 18 clinics serving young people aged 16-24 years with long-term conditions. METHODS This study uses both quantitative and qualitative approaches. Semistructured interviews were conducted with 173 clinical team members on the impacts of digital consulting. A structured questionnaire was developed and used for 115 health professionals across 12 health conditions at 18 sites in the United Kingdom to collect data on time and other resources used for digital consulting. A follow-up semistructured interview was conducted with a single senior clinician at each site to clarify the mechanisms through which digital consulting use might lead to outcomes relevant to economic evaluation. We used the two-part model to see the association between the time spent on digital consulting and the job role of staff, type of clinic, and the average length of the working hours using digital consulting. RESULTS When estimated using the two-part model, consultants spent less time on digital consulting compared with nurses (95.48 minutes; P<.001), physiotherapists (55.3 minutes; P<.001), and psychologists (31.67 minutes; P<.001). Part-time staff spent less time using digital consulting than full-time staff despite insignificant result (P=.15). Time spent on digital consulting differed across sites, and no clear pattern in using digital consulting was found. Health professionals qualitatively identified the following 4 potential economic impacts for the NHS: decreasing adverse events, improving patient well-being, decreasing wait lists, and staff workload. We did not find evidence to suggest that the clinical condition was associated with digital consulting use. CONCLUSIONS Nurses and physiotherapists were the greatest users of digital consulting. Teams appear to use an efficient triage system with the most expensive members digitally consulting less than lower-paid team members. Staff report showed concerns regarding time spent digitally consulting, which implies that direct costs increase. There remain considerable gaps in evidence related to cost-effectiveness of digital consulting, but this study has highlighted important cost-related outcomes for assessment in future cost-effectiveness trials of digital consulting.

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The self-management work of food hypersensitivity

PLoS ONE ◽

10.1371/journal.pone.0248181 ◽

2021 ◽

Vol 16 (3) ◽

pp. e0248181

Author(s):

Monika Dybdahl Jakobsen ◽

Aud Obstfelder ◽

Tonje Braaten ◽

Birgit Abelsen

Keyword(s):

Conventional Medicine ◽

Food Hypersensitivity ◽

The Self ◽

Food Allergies ◽

Self Management ◽

Long Term Conditions ◽

Individual Interviews ◽

Irritable Bowel ◽

Management Work

Background Food hypersensitivity (FH) has received considerable attention in the scientific community in recent years. However, little attention has been given to the efforts people make to manage their FH. We aimed to explore these efforts by using Normalization Process Theory, which is a conceptual framework formerly used to describe the self-management ‘work’ of long-term conditions. Methods We carried out qualitative individual interviews with 16 women with FH. Transcripts from recorded interviews were analyzed using template analysis. Results 16 women participated; some had diagnoses from conventional medicine (celiac disease, lactose intolerance, food allergies, irritable bowel syndrome) and some did not. Participants described carrying out several tasks, some of which were time-consuming, to manage their FH. Women who had clarified once and for all what food(s) caused symptoms, described that they could concentrate on carrying out a restricted diet, which could become routine. Conversely, participants who had not achieved such clarification described carrying out tasks to identify what food(s) caused symptoms, and to implement and evaluate a tentative diet. Participants’ descriptions also revealed a heightened vigilance when they ate food that others had prepared, and some made efforts to conceal their FH. Conclusions Self-management of FH may, like the self-management of other long-term conditions, imply a large workload and burden of treatment. Efforts made to conceal FH may be considered part of this workload, while help in clarifying which food(s) cause symptoms has the potential to reduce the workload.

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Patient activation in older people with long-term conditions and multimorbidity: correlates and change in a cohort study in the United Kingdom

BMC Health Services Research ◽

10.1186/s12913-016-1843-2 ◽

2016 ◽

Vol 16 (1) ◽

Cited By ~ 28

Author(s):

Amy Blakemore ◽

Mark Hann ◽

Kelly Howells ◽

Maria Panagioti ◽

Mark Sidaway ◽

...

Keyword(s):

Cohort Study ◽

United Kingdom ◽

Older People ◽

Patient Activation ◽

Long Term Conditions ◽

The United Kingdom

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Yoga and Healthcare in the United Kingdom

International Journal of Yoga Therapy ◽

10.17761/1531-2054-27.1.121 ◽

2017 ◽

Vol 27 (1) ◽

pp. 121-126 ◽

Cited By ~ 4

Author(s):

Heather Mason ◽

Nicole Schnackenberg ◽

Robin Monro

Keyword(s):

United Kingdom ◽

Treatment Options ◽

Cost Savings ◽

Cost Effective ◽

Long Term Conditions ◽

Yoga Therapy ◽

The Public ◽

The United Kingdom ◽

Regional Hospitals

Abstract The emergence of yoga therapy in the United Kingdom began about 45 years ago with the emergence of yoga therapy organizations that offered both treatment and training. The integration of yoga into the National Health Service (NHS) is gradually happening Because: (a) yoga research supports its efficacy as a cost-effective, preventive and complementary treatment for a host of non-communicable diseases; and (b) the escalating economic burden of long-term conditions is overwhelming the NHS. The NHS is actively developing ‘sustainability and transformation plans’ that include yoga. Chief among these is ‘social prescribing,’ which empowers patients with complex health needs through activities groups. These activities reduce sedentary habits and social isolation, while helping patients to be more self-reliant. The NHS has allocated £450 million in funding to implement a variety of programs for its own staff, in which staff yoga classes were expressly mentioned. The yoga community is mobilizing forces and applying for funding to pilot relevant NHS staff yoga courses that can support the service in achieving its vision. Research shows that integrating yoga therapy for the treatment of low back pain (LBP) into the NHS would result in significant cost savings as compared with usual care. The National Institute for Health and Care Excellence (NICE) Guidelines on LBP and sciatica include yoga as one of the recommended treatments for these conditions. Three groups of yoga teachers, using different yoga practices, have gained traction with the NHS for the application of yoga therapy to LBP. Many regional hospitals in England have yoga classes. The NHS Choices website, which conveys information to the public regarding treatment options, has a page dedicated to the health benefits of yoga. Several institutions offer comprehensive training programs in yoga therapy and yoga therapy is recognized as an official profession. The Yoga in Healthcare Alliance has been established to help integrate yoga therapy into the NHS. This consists of parliamentarians, leaders in the NHS, yoga researchers, health professionals, and representatives from leading yoga organizations.

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Self-management support? Listening to people with complex co-morbidities

Chronic Illness ◽

10.1177/1742395318796176 ◽

2018 ◽

Vol 16 (3) ◽

pp. 161-172 ◽

Cited By ~ 2

Author(s):

Helen Francis ◽

Jenny Carryer ◽

Jill Wilkinson

Keyword(s):

New Zealand ◽

Early Stage ◽

The Self ◽

Self Management ◽

Management Approach ◽

Management Support ◽

Long Term Conditions ◽

Early Stage Disease ◽

The Face

Objectives The study aimed to explore how people with complex, established co-morbidities experience long-term condition care in New Zealand. Despite the original conception as appropriate for people with early stage disease, in New Zealand the self-management approach dominates the care provided to people at all stages of diagnosis with long-term conditions, something reinforced through particular funding mechanisms. Methods A multiple case study followed the lives of 16 people with several long-term conditions. Data collection comprised two interviews, four weekly contacts with patients over an 18-month period and an interview with their primary health care clinicians. Results This paper reveals a cohort of tired, distracted patients struggling to manage their lives in the face of multiple conflicting challenges, with insufficient energy for the level of personal agency required to deal with the self-management approach. Discussion Participants described aspects of care received, which does meet their needs but sit outside the self-management approach, that resonate with the ideas behind current approaches to palliative care. The potential of an approach to care built upon these ideas is explored as a more compassionate, effective way of meeting the needs of people with advanced, multiple long-term conditions. Further research is warranted to explore the acceptability of such an approach.

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Patient expertise: Contested territory in the realm of long-term condition care

Chronic Illness ◽

10.1177/1742395318757853 ◽

2018 ◽

Vol 15 (3) ◽

pp. 197-209 ◽

Cited By ~ 7

Author(s):

Helen Francis ◽

Jenny Carryer ◽

Jill Wilkinson

Keyword(s):

The Self ◽

Self Management ◽

Management Approach ◽

Long Term Conditions ◽

Expert Patient ◽

Patient Expertise ◽

Primary Care Clinicians ◽

Management Approaches ◽

Cross Case Analysis

Objectives The aim of this study was to describe the experience of people with multiple long-term conditions with particular reference to the notion of the ‘expert patient’ in the context of self-management. Methods A multiple case study of 16 people with several long-term conditions, included interviews and contacts over an 18-month period and an interview with their primary care clinicians. Analysis included both case-by-case and some cross-case analysis. Results The findings reveal the patient participants had little capacity to exercise the agency necessary be an expert patient as premised. Weariness, shame, expertise, issues of compliance and control and collaboration are contested areas underpinning clinician encounters. Discussion Patient expertise is at the heart of self-management approaches but the findings surfaced several inherent contradictions between the idealised expert patient and their position within a health care system that is entrenched in biomedicine. Conclusion There is a mismatch between how the self-management approach has been operationalised and what the participants who have multiple LTCs reveal as what they want and need. The research concludes that the self-management approach is inappropriate for people with multiple LTCs and that other ways of offering care should be considered.

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