scholarly journals O4B.3 The impact of income support systems on healthcare quality and functional capacity in workers with LBP: a realist review

2019 ◽  
Vol 76 (Suppl 1) ◽  
pp. A34.3-A35
Author(s):  
Michael Di Donato ◽  
Ross Iles ◽  
Tyler Lane ◽  
Alex Collie
Keyword(s):  
Functional Capacity ◽  
Work Disability ◽  
Support Systems ◽  
Grey Literature ◽  
Healthcare Quality ◽  
Realist Review ◽  
Current Evidence ◽  
Income Support ◽  
Context Dependent ◽  
The Impact

BackgroundLow back pain (LBP) is a leading cause of work disability. While absent from work, workers with LBP may receive income support from a system such as workers’ compensation or social security. Current evidence suggests that income support systems can influence recovery from LBP, but provides little evidence as to why and how these effects occur. This study examines how and in what contexts income support systems impact the healthcare quality and functional capacity of people with work disability and LBP.MethodsWe performed a realist review, a type of literature review that seeks to explain how social interventions and phenomena in certain contexts generate outcomes, rather than simply whether or not they do. Five initial theories about the mechanisms of the relationship were developed, tested, and refined by acquiring and synthesising academic literature from purposive and iterative electronic database searching. This process was supplemented by grey literature searching for policy documents and legislative summaries, and semi-structured interviews with experts in income support, healthcare, and LBP.ResultsIncome support systems influence healthcare quality through healthcare funding restrictions, healthcare provider administrative burden, and allowing an employer to select healthcare providers. Income support systems influence worker functional capacity through the level of participation and share of income support funding required of employers, and through certain administrative procedures. These mechanisms are often exclusively context-dependent, and generate differing and unintended outcomes depending on features of the healthcare and income support system, as well as other contextual factors such as socioeconomic status and labour force composition.ConclusionIncome support systems impact the healthcare quality and functional capacity of people with work disability and LBP through context-dependent financial control, regulatory, and administrative mechanisms. Future policy design and research efforts should consider how income support systems may indirectly influence workers with LBP via the workplace.

scholarly journals The Impact of Income Support Systems on Healthcare Quality and Functional Capacity in Workers with Low Back Pain: A Realist Review

2020 ◽  
Author(s):  
Michael Di Donato ◽  
Ross Iles ◽  
Tyler Lane ◽  
Rachelle Buchbinder ◽  
Alex Collie
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Functional Capacity ◽  
Work Disability ◽  
Support Systems ◽  
Healthcare Quality ◽  
Realist Review ◽  
Low Back ◽  
Income Support ◽  
Context Dependent

ABSTRACTBackgroundLow back pain (LBP) is a leading cause of work disability. While absent from work, workers with LBP may receive income support from a system such as workers’ compensation or social security. Current evidence suggests that income support systems can influence recovery from LBP, but provides little insight as to why and how these effects occur. This study examines how and in what contexts income support systems impact the healthcare quality for people with work disability and LBP and their functional capacity.MethodsWe performed a realist review, a type of literature review that seeks to explain how social interventions and phenomena in certain contexts generate outcomes, rather than simply whether they do. Five initial theories about the relationship between income support systems and outcomes were developed, tested, and refined by acquiring and synthesising academic literature from purposive and iterative electronic database searching. This process was supplemented with grey literature searches for policy documents and legislative summaries, and semi-structured interviews with experts in income support, healthcare and LBP.ResultsIncome support systems influence healthcare quality through funding restrictions, healthcare provider administrative burden, and allowing employers to select providers. They also influence worker functional capacity through the level of participation and financial incentives for employers, measures to prove the validity of the worker’s LBP, and certain administrative procedures. These mechanisms are often exclusively context-dependent, and generate differing and unintended outcomes depending on features of the healthcare and income support system, as well as other contextual factors such as socioeconomic status and labour force composition.DiscussionIncome support systems impact the healthcare quality and functional capacity of people with work disability and LBP through context-dependent financial control, regulatory and administrative mechanisms. Research and policy design should consider how income support systems may indirectly influence workers with LBP via the workplace.

scholarly journals The impact of income support systems on healthcare quality and functional capacity in workers with low back pain: a realist review

Pain ◽  
2020 ◽  
Vol 161 (12) ◽  
pp. 2690-2709
Author(s):  
Michael Di Donato ◽  
Ross Iles ◽  
Tyler Lane ◽  
Rachelle Buchbinder ◽  
Alex Collie
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Functional Capacity ◽  
Support Systems ◽  
Healthcare Quality ◽  
Realist Review ◽  
Low Back ◽  
Income Support ◽  
The Impact

scholarly journals Conversations about FGM in primary care: a realist review on how, why and under what circumstances FGM is discussed in general practice consultations

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e039809
Author(s):  
Sharon Dixon ◽  
Claire Duddy ◽  
Gabrielle Harrison ◽  
Chrysanthi Papoutsi ◽  
Sue Ziebland ◽  
...  
Keyword(s):  
Primary Care ◽  
Grey Literature ◽  
Relevant Literature ◽  
Theory Development ◽  
Realist Review ◽  
Primary Outcome Measure ◽  
Mandatory Reporting ◽  
Programme Theory ◽  
Genital Mutilation ◽  
The Impact

ObjectivesLittle is known about the management of female genital mutilation (FGM) in primary care. There have been significant recent statutory changes relevant to general practitioners (GPs) in England, including a mandatory reporting duty. We undertook a realist synthesis to explore what influences how and when GPs discuss FGM with their patients.SettingPrimary care in England.Data sourcesRealist literature synthesis searching 10 databases with terms: GPs, primary care, obstetrics, gynaecology, midwifery and FGM (UK and worldwide). Citation chasing was used, and relevant grey literature was included, including searching FGM advocacy organisation websites for relevant data. Other potentially relevant literature fields were searched for evidence to inform programme theory development. We included all study designs and papers that presented evidence about factors potentially relevant to considering how, why and in what circumstances GPs feel able to discuss FGM with their patients.Primary outcome measureThis realist review developed programme theory, tested against existing evidence, on what influences GPs actions and reactions to FGM in primary care consultations and where, when and why these influences are activated.Results124 documents were included in the synthesis. Our analysis found that GPs need knowledge and training to help them support their patients with FGM, including who may be affected, what needs they may have and how to talk sensitively about FGM. Access to specialist services and guidance may help them with this role. Reporting requirements may complicate these conversations.ConclusionsThere is a pressing need to develop (and evaluate) training to help GPs meet FGM-affected communities’ health needs and to promote the accessibility of primary care. Education and resources should be developed in partnership with community members. The impact of the mandatory reporting requirement and the Enhanced Dataset on healthcare interactions in primary care warrants evaluation.PROSPERO registration numberCRD42018091996.

scholarly journals Realist evaluation of Autism ServiCe Delivery (RE-ASCeD): which diagnostic pathways work best, for whom and in what context? Findings from a rapid realist review

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e051241
Author(s):  
Vanessa Abrahamson ◽  
Wenjing Zhang ◽  
Patricia M Wilson ◽  
William Farr ◽  
Venkat Reddy ◽  
...  
Keyword(s):  
Service Delivery ◽  
Grey Literature ◽  
Realist Review ◽  
Current Evidence ◽  
Diagnostic Model ◽  
High Quality ◽  
Current Evidence Base ◽  
The Uk ◽  
Diagnostic Pathways ◽  
Rapid Realist Review

ObjectivesWaiting times in the UK for an autism diagnostic assessment have increased rapidly in the last 5 years. This review explored research (including ‘grey’ literature) to uncover the current evidence base about autism diagnostic pathways and what works best, for whom and in what circumstances, to deliver high quality and timely diagnosis.DesignWe performed a Rapid Realist Review consistent with recognised standards for realist syntheses. We collected 129 grey literature and policy/guidelines and 220 articles from seven databases (January 2011–December 2019). We developed programme theories of how, why and in what contexts an intervention worked, based on cross comparison and synthesis of evidence. The focus was on identifying factors that contributed to a clearly defined intervention (the diagnostic pathway), associated with specific outcomes (high quality and timely), within specific parameters (Autism diagnostic services in Paediatric and Child & Adolescent Mental Health services in the UK). Our Expert Stakeholder Group, including representatives from local parent forums, national advocacy groups and clinicians, was integral to the process.ResultsBased on 45 relevant articles, we identified 7 programme theories that were integral to the process of diagnostic service delivery. Four were related to the clinical pathway: initial recognition of possible autism; referral and triaging; diagnostic model; and providing feedback to parents. Three programme theories were pertinent to all stages of the referral and diagnostic process: working in partnership with families; interagency working; and training, service evaluation and development.ConclusionsThis theory informed review of childhood autism diagnostic pathways identified important aspects that may contribute to efficient, high quality and family-friendly service delivery. The programme theories will be further tested through a national survey of current practice and in-depth longitudinal case studies of exemplar services.Trial registration numberNCT04422483.

scholarly journals Caregiver-mediated interventions to support self-regulation among infants and young children (0–5 years): a protocol for a realist review

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e046078
Author(s):  
Amy Finlay-Jones ◽  
Jetro Emanel Ang ◽  
Elaine Bennett ◽  
Jenny Downs ◽  
Sally Kendall ◽  
...  
Keyword(s):  
School Readiness ◽  
Working Group ◽  
Protective Factor ◽  
Evidence Synthesis ◽  
Grey Literature ◽  
Self Regulation ◽  
Realist Review ◽  
Programme Theory ◽  
Review Team ◽  
The Impact

IntroductionSelf-regulation is a modifiable protective factor for lifespan mental and physical health outcomes. Early caregiver-mediated interventions to promote infant and child regulatory outcomes prevent long-term developmental, emotional and behavioural difficulties and improve outcomes such as school readiness, educational achievement and economic success. To harness the population health promise of these programmes, there is a need for more nuanced understanding of the impact of these interventions. The aim of this realist review is to understand how, why, under which circumstances and for whom, early caregiver-mediated interventions improve infant and child self-regulation. The research questions guiding this review were based on consultation with families and community organisations that provide early childhood and family services.Methods and analysisRealist reviews take a theory-driven and iterative approach to evidence synthesis, structured around continuous refinement of a programme theory. Programme theories specify context-mechanism-outcome configurations to explain what works, for whom, under which circumstances and how. Our initial programme theory is based on prior work in this field and will be refined through the review process. A working group, comprising service users, community organisation representatives, representatives from specific populations, clinicians and review team members will guide the evidence synthesis and interpretation, as well as the development and dissemination of recommendations based on the findings of the review. The review will involve searching: (i) electronic databases, (ii) connected papers, articles and citations and (iii) grey literature. Decisions to include evidence will be guided by judgements about their contribution to the programme theory and will be made by the research team, with input from the working group. Evidence synthesis will be reported using the Realist and MEta-narrative Evidence Synthesis: Evolving Standards guidelines.Ethics and disseminationEthical approval is not required as this is a review. Findings will be disseminated to our working group and through peer-reviewed publications and conference presentations.Review registration numberThe protocol is registered with Open Science Framework https://osf.io/5ce2z/registrations.

scholarly journals Public Health and Health Systems Impacts of SARS-CoV-2 Variants of Concern: A Rapid Scoping Review

2021 ◽  
Author(s):  
Janet A Curran ◽  
Justine Dol ◽  
Leah Boulos ◽  
Mari Somerville ◽  
Bearach Reynolds ◽  
...  
Keyword(s):  
Public Health ◽  
Health System ◽  
Health Systems ◽  
Scoping Review ◽  
Grey Literature ◽  
Current Evidence ◽  
Risk Of Death ◽  
Health Measures ◽  
Guidance Documents ◽  
The Impact

Background: As of April 2021, three SARS-CoV-2 variants of concern (VOC: B.1.1.7, B.1.351 and P.1) have been detected in over 132 countries. Increased transmissibility of VOC has implications for public health measures and health system arrangements. This rapid scoping review aims to provide a synthesis of current evidence related to public health measures and health system arrangements associated with VOC. Methods: Rapid scoping review. Seven databases were searched up to April 7, 2021 for terms related to VOC, transmission, public health and health systems. A grey literature search was conducted up to April 14, 2021. Title, abstracts and full text were screened independently by two reviewers. Data were double extracted using a standardized form. Studies were included if they reported on at least one of the VOC and public health or health system outcomes. Results: Of the 2487 articles and 59 grey literature sources retrieved, 37 studies and 21 guidance documents were included. Included studies used a wide range of designs and methods. Most of the studies and guidance documents reported on B.1.1.7, and 18 studies and 4 reports provided data for consideration in relation to public health measures. Public health measures, including lockdowns, physical distancing, testing and contact tracing, were identified as critical adjuncts to a comprehensive vaccination campaign. No studies reported on handwashing or masking procedures related to VOC. For health system arrangements, 17 studies were identified. Some studies found an increase in hospitalization due to B.1.1.7 but no difference in length of stay or ICU admission. Six studies found an increased risk of death ranging from 15-67% with B.1.1.7 compared non-B.1.1.7, but three studies reported no change. One study reported on the effectiveness of personal protective equipment in reducing VOC transmission in the hospital. No studies reported on screening staff and visitors, adjusting service provisions, or adjusting patient accommodations and shared spaces, which is a significant gap in the literature. Guidance documents did not tend to cite any evidence and were thus assumed to be based on expert opinion. Conclusion: While the findings should be interpreted with caution as most of the sources identified were preprints, findings suggest a combination of non-pharmaceutical interventions (e.g., masking, physical distancing, lockdowns, testing) should be employed alongside a vaccine strategy to improve population and health system outcomes. While the findings are mixed on the impact of VOC on health system arrangements, the evidence is trending towards increased hospitalization and death.

scholarly journals Delegating home visits in general practice: a realist review on the impact on GP workload and patient care

2020 ◽  
Vol 70 (695) ◽  
pp. e412-e420 ◽  
Author(s):  
Ruth Abrams ◽  
Geoff Wong ◽  
Kamal R Mahtani ◽  
Stephanie Tierney ◽  
Anne-Marie Boylan ◽  
...  
Keyword(s):  
General Practice ◽  
Healthcare Professionals ◽  
Hospital Admissions ◽  
Grey Literature ◽  
Home Visits ◽  
Secondary Data ◽  
Realist Review ◽  
Causal Explanations ◽  
New Ways Of Working ◽  
The Impact

BackgroundUK general practice is being shaped by new ways of working. Traditional GP tasks are being delegated to other staff with the intention of reducing GPs’ workload and hospital admissions, and improving patients’ access to care. One such task is patient-requested home visits. However, it is unclear what impact delegated home visits may have, who might benefit, and under what circumstances.AimTo explore how the process of delegating home visits works, for whom, and in what contexts.Design and settingA review of secondary data on home visit delegation processes in UK primary care settings.MethodA realist approach was taken to reviewing data, which aims to provide causal explanations through the generation and articulation of contexts, mechanisms, and outcomes. A range of data has been used including news items, grey literature, and academic articles.ResultsData were synthesised from 70 documents. GPs may believe that delegating home visits is a risky option unless they have trust and experience with the wider multidisciplinary team. Internal systems such as technological infrastructure might help or hinder the delegation process. Healthcare professionals carrying out delegated home visits might benefit from being integrated into general practice but may feel that their clinical autonomy is limited by the delegation process. Patients report short-term satisfaction when visited by a healthcare professional other than a GP. The impact this has on long-term health outcomes and cost is less clear.ConclusionThe delegation of home visits may require a shift in patient expectation about who undertakes care. Professional expectations may also require a shift, having implications for the balance of staffing between primary and secondary care, and the training of healthcare professionals.

scholarly journals Reducing Old Age Vulnerabilities in Developing Countries: The Role of Income-Support on Poor Older People’s Health

2020 ◽  
Vol 14 (1) ◽  
pp. 1-16 ◽  
Author(s):  
Oladayo Nathaniel Awojobi ◽  
Jane Temidayo Abe
Keyword(s):  
Developing Countries ◽  
Mixed Methods ◽  
Older People ◽  
Grey Literature ◽  
Healthcare Services ◽  
Income Support ◽  
Inclusion Criteria ◽  
Positive Effects ◽  
The Impact

This systematic review is on the impact of income-support on older people’s health in developing countries. A systematic search for non-randomised and mixed methods studies published between 2013 and 2017 was conducted in academic and grey literature databases, websites and references lists of relevant studies. Study methodological quality was assessed with a risk of bias tool. Inclusion criteria were met by 7 studies, 3 in Latin America, two each in Africa and Asia. Five of the studies used a quantitative non-randomised approach while the remaining two used mixed methods analysis. Income-support was discovered to have positive effects on older people’s nutritional status, cognitive functions, health and psychological wellbeing. Income-support offers older people access to healthcare services and protection against detrimental effects of lack of money in accessing healthcare services. Key Words: Health, income-support, older people

scholarly journals A systematic review of mindfulness based interventions for children and young people with ADHD and their parents

2019 ◽  
Vol 2 (1) ◽  
pp. 79-96 ◽  
Author(s):  
Illaria Tercelli ◽  
Nuno Ferreira
Keyword(s):  
Family Functioning ◽  
Parental Stress ◽  
Grey Literature ◽  
Later Life ◽  
Current Evidence ◽  
Children And Young People ◽  
Children With Adhd ◽  
Hyperactivity Disorder ◽  
The Impact ◽  
Positive Results

AbstractObjectiveAttention deficit hyperactivity disorder (ADHD) is one of the most prevalent disorders in childhood, which may pose risks in later life such as academic underachievement and anti-social behaviour. It has been suggested that mindfulness-based interventions (MBI) may contribute to positive outcomes with child and adult populations. In this article, we aim to systematically review the literature regarding the effectiveness of MBI on both children with ADHD and their parents.MethodSeven databases were searched using the PRISMA criteria and included peer-reviewed journals and grey literature.ResultsTen studies met the inclusion criteria. Findings suggested that MBI had positive results in addressing attention deficits in children with ADHD, but in terms of hyperactivity, the evidence was conflicting. MBI interventions also appear to effectively address parental stress and family functioning. However, the rating from the quality assessment showed several methodological limitations.DiscussionThe current evidence on the impact of MBI on ADHD symptoms is non-conclusive. However, promising data indicated the potential for MBI in addressing parental stress and family functioning. Further research is recommended to overcome the current methodological limitations.

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