scholarly journals Long-term condition management for prisoners: improving the processes between community and prison

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
NMJ Wright ◽  
F Hankins ◽  
P Hearty
Keyword(s):  
Qualitative Interviews ◽  
Electronic Record ◽  
Medicines Management ◽  
Long Term Conditions ◽  
Police Custody ◽  
Barriers To Screening ◽  
High Prevalence ◽  
Facilitators And Barriers ◽  
Ongoing Monitoring

Abstract Background Prisoner populations have a disproportionately high prevalence of risk factors for long-term conditions (LTCs), and movement between community and prisons is a period of potential disruption in the ongoing monitoring and management of LTCs. Method Nineteen qualitative interviews with staff, recruited by purposive sampling for professional background, were conducted to explore facilitators and barriers to screening, monitoring and medicines management for LTCs. Results There is variability in prisoner behaviours regarding bringing community GP-prescribed medication to prison following arrest and detention in police custody, which affects service ability regarding seamless continuation of community prescribing actions. Systems for actively inputting clinical data into existing, nationally agreed, electronic record templates for QOF monitoring are under-developed in prisons and such activity is dependent upon individual “enthusiast(s)”. Conclusion There is a pressing need to embed standardised QOF monitoring systems within an integrated community/prison commissioning framework, supported by connectivity between prison and community primary care records, including all activity related to QOF compliance.

scholarly journals Long-term Condition Management for Prisoners: improving the processes between community and prison

2021 ◽  
Author(s):  
Nat Wright ◽  
F Hankins ◽  
P Hearty
Keyword(s):  
Qualitative Interviews ◽  
Electronic Record ◽  
Medicines Management ◽  
Long Term Conditions ◽  
Police Custody ◽  
Barriers To Screening ◽  
High Prevalence ◽  
Facilitators And Barriers ◽  
Ongoing Monitoring

Abstract Background: Prisoner populations have a disproportionately high prevalence of risk factors for long-term conditions (LTCs), and movement between community and prisons is a period of potential disruption in the ongoing monitoring and management of LTCs.Method: 19 qualitative interviews with staff, recruited by purposive sampling for professional background, were conducted to explore facilitators and barriers to screening, monitoring and medicines management for LTCs.Results: There is variability in prisoner behaviours regarding bringing community GP-prescribed medication to prison following arrest and detention in police custody, which affects service ability regarding seamless continuation of community prescribing actions. Systems for actively inputting clinical data into existing, nationally agreed, electronic record templates for QOF monitoring are under-developed in prisons and such activity is dependent upon individual “enthusiast(s)”.Conclusion: There is a pressing need to embed standardised QOF monitoring systems within an integrated community/prison commissioning framework, supported by connectivity between prison and community primary care records, including all activity related to QOF compliance.

scholarly journals Long-term Condition Management for Prisoners: Improving the Interface Between Community and Prison

2020 ◽  
Author(s):  
Nat Wright ◽  
F Hankins ◽  
P Hearty
Keyword(s):  
Qualitative Interviews ◽  
Electronic Record ◽  
Monitoring Systems ◽  
Medicines Management ◽  
Long Term Conditions ◽  
Barriers To Screening ◽  
High Prevalence ◽  
Community Systems

Abstract Background: Prisoner populations have a disproportionately high prevalence of risk factors for long-term conditions (LTCs), and movement between community and prisons is a period of potential disruption in the ongoing monitoring and management of LTCs. Method: 19 qualitative interviews with staff, recruited by purposive sampling for professional background, were conducted to explore facilitators and barriers to screening, monitoring and medicines management for LTCs.Results: There is variability in prisoner behaviours regarding bringing community GP-prescribed medication to prison following arrest and detention in police custody, which affects service ability regarding seamless continuation of community prescribing actions. Systems for actively inputting clinical data into existing, nationally agreed, electronic record templates for QOF monitoring are under-developed in prisons and such activity is dependent upon individual “enthusiast(s)”. Similarly, compared to community systems, prison-based systems for “e-prescribing” functionality are under-developed. Conclusion: There is a pressing need to embed standardised QOF monitoring systems within an integrated community/prison commissioning framework, supported by connectivity between prison and community primary care records, including all activity related to QOF compliance. Developing systems for e-prescribing and wider medicines management can improve the quality of care for LTCs. Prison-based general practice has historically not been equivalent to that offered in community settings. Current pressing threats to community equivalence are that QOF monitoring systems are not embedded within prison healthcare payment structures and prison e-prescribing systems are underdeveloped. Supporting wider connectivity between prison and community GP records, including all activity related to QOF compliance and developing systems for e-prescribing had the potential to improve the quality of LTC care for this vulnerable group.

scholarly journals Improving the Care of People with Long-Term Conditions in Primary Care: Protocol for the Enhance Pilot Trial

2015 ◽  
Vol 5 (1) ◽  
pp. 135-149 ◽  
Author(s):  
Emma L. Healey ◽  
Clare Jinks ◽  
Valerie A. Tan ◽  
Carolyn A. Chew-Graham ◽  
Sarah A. Lawton ◽  
...  
Keyword(s):  
Primary Care ◽  
Controlled Trial ◽  
Qualitative Interviews ◽  
Pilot Trial ◽  
Integrated Approach ◽  
Long Term Conditions ◽  
Delivery Of Care ◽  
Care Protocol ◽  
Engagement Assessment

Background Long-term conditions (LTCs) are important determinants of quality of life and healthcare expenditure worldwide. Whilst multimorbidity is increasingly the norm in primary care, clinical guidelines and the delivery of care remain focused on single diseases, resulting in poorer clinical outcomes. Osteoarthritis, and anxiety and/or depression frequently co-occur with other LTCs, yet are seldom prioritized by the patient or clinician, resulting in higher levels of disability, poorer prognosis, and increased healthcare costs. Objective To examine the feasibility and acceptability of an integrated approach to LTC management, tackling the under-diagnosis and under-management of osteoarthritis-related pain and anxiety and/or depression in older adults with other LTCs in primary care. Design The ENHANCE study is a pilot stepped-wedge cluster randomized controlled trial to test the feasibility and acceptability of a nurse-led ENAHNCE LTC review consultation for identifying, assessing, and managing joint pain, and anxiety and/or depression in patients attending LTC reviews. Specific objectives (process evaluation and research outcomes) will be achieved through a theoretically informed mixed-methods approach using participant self-reported questionnaires, a medical record review, an ENHANCE EMIS template, qualitative interviews, and audio recordings of the ENHANCE LTC review. Discussion Success of the pilot trial will be measured against the level of the primary care team engagement, assessment of training delivery, and degree of patient recruitment and retention. Patient satisfaction and treatment fidelity will also be explored. ISRCTN registry number: 12154418.

6 Medicines in schools – a survey of stakeholders

2018 ◽  
Vol 103 (2) ◽  
pp. e2.46-e2
Author(s):  
Jennifer Bellis
Keyword(s):  
Primary Schools ◽  
Healthcare Professionals ◽  
Access To Medicines ◽  
School Staff ◽  
Term Therapy ◽  
Free Text ◽  
Medicines Management ◽  
Long Term Conditions ◽  
Controlled Drugs

AimTo determine the perspectives of stakeholders on how children’s medicines are dealt with in schools.MethodsStakeholders were children with long-term conditions or receiving intermittent medicines and their families, school staff and healthcare professionals. Between August 2015 and July 2016, children on long term therapy and their parents/guardians completed a paper-based questionnaire. Parents of children receiving intermittent medicines took part in a telephone survey. Other stakeholders completed electronic questionnaires. Questions related to medicine type, administration, storage, record-keeping, staff training, communication and problems encountered. Quantitative data are presented using summary statistics, free text responses were categorised by theme.ResultsResponses were received from 59 healthcare professionals, 24 parents of children with long term conditions and 15 children with long term conditions, 10 parents of children receiving intermittent medicines, 40 school staff and 11 school nurses. The age range of the children who completed the questionnaire (or had it completed by their parent) was 4–16 years. The number of regular medicines taken at school ranged from 0 to 4, the number of medicines taken at school when required ranged from 0% to 12. 72.5% of school staff respondents were from primary schools (±nursery), 20.0% from secondary and 7.5% from schools for pupils with special needs. Children needed to take oral and buccal medicines, inhalers, nebulised treatment, topical, rectal and injectables at school.57.6% of healthcare professional respondents were aware of problems encountered by patients with medicines at school. 47.1% of school staff respondents said there were challenges with the administration of medicines. 52.5% said there was some room for improvement in how they managed medicines at their school. 54.5% of school nurse respondents were aware of problems with medicines at school. 41.7% of parent and 66.7% of child respondents reported at least one problem. Four parents of children receiving intermittent treatment said that their child needed to take their medicine during the school day. One was very unsatisfied with how the medicines were dealt with at school. The most common problems reported by all stakeholder groups were missed doses, medicine not available when required and medicine supply running out. Medicines perceived to cause particular problems were: medicines needing fridge storage, antibiotics, inhalers, nebulisers, controlled drugs, buccal midazolam, rectal diazepam, insulin, hydrocortisone, Creon, carnitine, baclofen and Epipen. Clinicians and parents try to avoid children and young people needing to take medicines at school but this isn’t always possible. In general, schools are accommodating of the needs of children requiring medication at school but school staff reported a number of challenges such as appropriate storage and access to medicines, clear instructions, and liaising with healthcare practitioners. Schools reported a lack of expertise about medicines and therefore relied on adherence to systems, policies and procedures as an indication of the quality of medicines management.ConclusionThere are challenges associated with medicines management at school. Future work should focus on addressing the areas of concern highlighted by stakeholders, in particular: storage of, and access to, medicines and communication about medicines.

Keeping Up to Date

2013 ◽  
Author(s):  
Graham Brack ◽  
Penny Franklin ◽  
Jill Caldwell
Keyword(s):  
Patient Safety ◽  
Clinical Supervision ◽  
Community Setting ◽  
Medicines Management ◽  
Long Term Conditions ◽  
The World ◽  
Medical Healthcare ◽  
Efficacy Of Treatment

● To gain an understanding of strategies that can be used to keep your skills in medicines management up to date, including clinical supervision and change management. ● To acknowledge the implications of clinical governance as related to keeping up to date within medicines management. It is hoped that this book will provide a useful resource in the future to help keep your skills and knowledge up to date. This final chapter covers some of the strategies that may help. It will discuss some of the relevant developments and offer some thoughts about future advances in medicines management. The world of medicines management is constantly evolving although, having said that there are given constants and principles that will remain the same in all settings. For example, patient safety is obviously in the forefront of all practice as is efficacy of treatment and effective resource management. As explained within the context of this book there are a number of ways of ensuring that the instructions for giving medicines are clear and that medicines are legally and safely dispensed, supplied, and administered to patients. Other terms for ways to dispense, supply, or administer medicines are process or mechanism. Some of these mechanisms have been in place for many years; for example, before the Medicines Act 1968 . Others have been enforced more recently; nonmedical prescribing only came into being in the mid- 1990s and continues to expand in the current decade (Association for Nurse Prescribers). It can be safely stated that all of the legal mechanisms for the dispensing, supply, and administration of medicines have been reviewed and tightened up either locally, nationally, or both within the last 10 years. This reinforcement has occurred because of the following factors; you may be able to think of more:… ● Concerns about patient safety and medicines management. ● Directives for a changing and evolving health service moving, for example, towards the management of the care of patients with long term conditions in the community setting. ● Delivery of medicines management by more advanced non-medical healthcare practitioners other than doctors, such as nurses and pharmacists. ● As a result of the Fourth Shipman Report. (2004).

scholarly journals Exploring The Use of Health and Wellbeing Measures During Pregnancy and The First Year Following Birth in Women Living With Pre-Existing Long-Term Conditions: Qualitative Interviews With Women and Healthcare Professionals

2021 ◽  
Author(s):  
Laura Kelly ◽  
Jennifer J Kurinczuk ◽  
Oliver Rivero-Arias ◽  
Ray Fitzpatrick ◽  
Elizabeth Gibbons ◽  
...  
Keyword(s):  
Healthcare Professionals ◽  
Qualitative Interviews ◽  
Well Being ◽  
Postpartum Women ◽  
Structured Interviews ◽  
Long Term Conditions ◽  
Maternity Services ◽  
Telephone Interviews ◽  
Health And Wellbeing

Abstract BackgroundOne way in which care for pregnant and postpartum women living with long-term health conditions (LTCs) may be improved is through the adoption of standardised measures to provide evidence of health outcomes and wellbeing from the woman’s perspective. AimWe aimed to explore the views of pregnant and postpartum women living with LTCs, and healthcare professionals to better understand the potential value of using standardised health and wellbeing measures within this patient population.MethodsQualitative semi-structured telephone interviews were conducted to explore the perceived value of using measures with pregnant and postpartum women living with LTCs within maternity services. Participants were asked to provide feedback on three exemplar measures: the Long Term Conditions Questionnaire, the Well-being in Pregnancy Questionnaire and the EuroQol EQ-5D-5L instrument. Thematic analysis was used in the analysis of the transcripts. ResultsEleven women and 11 healthcare professionals took part in semi-structured interviews. Analysis identified five themes as relevant to the use of measures within maternity services: 1) Improving care, 2) Assessing outcomes, 3) Interpretation and application of data, 4) Engagement challenges and implementation and, 5) Women and healthcare professionals alignment.ConclusionsDespite varying prior experience and expressing some questions about implementation, respondents were cautiously positive about the use of standardised health and well-being measures. Their use offers the opportunity for both affected women and healthcare professionals caring for them to collectively identify and assess important areas of unmet needs and improve outcomes. Incorporating the perspectives of women with LTC’s will help to bring awareness to elements of women centred care which health services may seek to address.

scholarly journals Exploring the use of health and wellbeing measures during pregnancy and the first year following birth in women living with pre-existing long-term conditions: qualitative interviews with women and healthcare professionals

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Laura Kelly ◽  
Jennifer J. Kurinczuk ◽  
Oliver Rivero-Arias ◽  
Ray Fitzpatrick ◽  
Elizabeth Gibbons ◽  
...  
Keyword(s):  
Healthcare Professionals ◽  
Qualitative Interviews ◽  
First Year ◽  
Postpartum Women ◽  
Structured Interviews ◽  
Long Term Conditions ◽  
Maternity Services ◽  
Telephone Interviews ◽  
Health And Wellbeing

Abstract Background One way in which care for pregnant and postpartum women living with long-term health conditions (LTCs) may be improved is through the adoption of standardised measures to provide evidence of health outcomes and wellbeing from the woman’s perspective. Aim The study explores the views of pregnant and postpartum women living with LTCs, and healthcare professionals to better understand the potential value of using standardised health and wellbeing measures within this patient population. Methods Qualitative semi-structured telephone interviews were conducted to explore the perceived value of using measures with pregnant and postpartum women living with LTCs within maternity services. Participants were asked to provide feedback on three exemplar measures: the Long Term Conditions Questionnaire, the Wellbeing in Pregnancy Questionnaire and the EuroQol EQ-5D-5L instrument. Thematic analysis was used in the analysis of the transcripts. Results Eleven women and 11 healthcare professionals took part in semi-structured interviews. Analysis identified five themes as relevant to the use of measures within maternity services: 1) Improving care, 2) Assessing outcomes, 3) Interpretation and application of data, 4) Engagement challenges and implementation and, 5) Women and healthcare professionals alignment. Conclusions Despite varying prior experience and expressing some questions about implementation, respondents were cautiously positive about the use of standardised health and wellbeing measures. Their use offers the opportunity for both affected women and healthcare professionals caring for them to collectively identify and assess important areas of unmet needs and improve outcomes. Incorporating the perspectives of women with LTC’s will help bring awareness to elements of women centred care which health services may seek to address.

scholarly journals Long-term Condition Management for Prisoners: exploring prevalence and compliance with QOF monitoring

2020 ◽  
Author(s):  
Nat Wright ◽  
F Hankins ◽  
P Hearty ◽  
D Allott ◽  
V Allgar
Keyword(s):  
Risk Factors ◽  
Primary Care ◽  
Prison Population ◽  
Female Gender ◽  
Self Report ◽  
Chronic Obstructive ◽  
Supporting Evidence ◽  
Long Term Conditions ◽  
High Prevalence

Abstract Background: Long-term conditions (LTCs) are a significant cause of morbidity and mortality and prisoner populations have a disproportionately high prevalence of risk factors for LTCs. The size and mean age of the prison population has increased rapidly in recent years. The UK Quality Outcomes Framework (QOF) is a national standardised framework embedded in community general practice with financial remuneration linked to assessment and ongoing review of key clinical outcomes pertaining to LTCs. However, healthcare in prisons in England is not linked to financial remuneration through the QOF framework and prison clinicians are not mandated to adhere to the framework.Methods: Secondary data analysis of data extracted from the prison primary care record pertaining to patient self-report of LTC, level of confirmation by supporting evidence and compliance with QOF monitoring frameworks. Results: 17% of the sample had at least one LTC, the most common condition being asthma, confirmed in 12% of the sample. Having an LTC was associated with female gender and increasing age. Prevalence rates for the other LTCs were hypertension 3%, epilepsy was 3%, coronary heart disease 2%, diabetes 2% and chronic obstructive pulmonary disease 1%. Just 34% of the eligible sample had had a QOF template completed. Higher rates of completion were associated with younger age and there were also statistically significant inter-prison differences. Conclusion: There is a pressing need to embed standardised QOF monitoring systems within an integrated community/prison commissioning framework supported by connectivity between prison and community primary care records of not just the summary care record but also all activity related to QOF compliance. Amongst prisoner populations, there is high prevalence of risk factors for long-term conditions. This research quantifies the burden of disease and highlights under-developed systems for monitoring. There is an opportunity to enhance connectivity between community and prison GP settings to facilitate seamless monitoring of QOF outcomes.

scholarly journals Changing perspectives of the role of community pharmacists: 1998 – 2012

2017 ◽  
Vol 9 (1) ◽  
pp. 34 ◽  
Author(s):  
Linda Bryant ◽  
Joanne Maney ◽  
Nataly Martini
Keyword(s):  
Community Pharmacists ◽  
Continuous Variable ◽  
Working Relationships ◽  
Medicines Management ◽  
Long Term Conditions ◽  
Comparison Results ◽  
Management Roles ◽  
Interprofessional Working

ABSTRACT INTRODUCTION In New Zealand, extended medicines management roles proposed for pharmacists include the optimisation and monitoring of medicines in patients with long-term conditions through greater collaboration with general practitioners (GPs). Although some collaborative roles have been successfully implemented in hospitals, barriers for both pharmacists and GPs hinder interprofessional working relationships in the community. AIM To compare data from a 2012 study with two previous studies (1998, 2002) examining perceptions of community pharmacists and GPs of the expanding medicines management roles of community pharmacists. METHODS In 2012, a survey, modelled on the 1998 and 2002 studies, was sent to 600 community pharmacists and 600 GPs. Analyses considered the five-point Likert scale to be a continuous variable. A change of ≥ 10% between any two surveys indicated a relevant change for comparison. RESULTS Increasing agreement, which differed considerably between professions, was apparent for most expanding medicine management roles over the 14 study years. In all three studies, pharmacists were open to expanding their roles to include monitoring, screening, advisory and prescribing roles. GPs were most accepting of the traditional dispensing role with a positive shift towards pharmacists’ involvement in medicines management over time. DISCUSSION Over 14 years, GPs became more accepting of community pharmacists’ involvement in extended medicines management roles, although still had low acceptance of the more clinical roles. Pharmacists considered increased involvement in medicines management as their role, but appeared to lack confidence in their ability to do this role.

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