scholarly journals Resource allocation decision-making in dementia care with and without budget constraints: a qualitative analysis

2020 ◽  
Vol 3 ◽  
pp. 69
Author(s):  
Fiona Keogh ◽  
Tom Pierse ◽  
Eamon O'Shea ◽  
Christine Fitzgerald ◽  
David Challis
Keyword(s):  
Decision Making ◽  
Resource Allocation ◽  
Resource Constraints ◽  
Nominal Group Technique ◽  
Budget Constraint ◽  
Dementia Care ◽  
Assessment Process ◽  
Nominal Group ◽  
People With Dementia ◽  
Health And Social Care

Introduction: Health systems in many different countries have increasingly been reorienting the delivery of dementia care to home and community care settings. This paper provides information on how health and social care professionals (HSCPs) in Ireland make decisions on resource allocation for people with dementia living at home and how resource constraints affect their decisions and choices. Methods: A balance of care approach was used to assess resource allocation across six dementia case types, from low to high needs. Workshops were held with 24 HSCPs from multiple disciplines. Participants allocated services in two scenarios: allocation with and without a budget constraint. Nominal group technique was used to structure discussions around resource allocation in both scenarios. Thematic analysis was applied to analyse the qualitative data using a general inductive approach. Results: The following themes influenced allocative deliberations: whose needs are being met; what needs are identified; decision making context; decision making process; and allocation outcomes. Participants were proficient in making decisions, using ‘decision rules’ or heuristics to help them make decisions under fixed budget rules and sticking to conventional provision when constraints were in place. Conclusions: Freedom from a budget constraint allowed HSCPs to consider a broader range of services and to take a more expansive view on what needs should be considered, with a particular emphasis on adopting a proactive, preventative approach to the allocation of resources. The effect of the budget constraint overall was to narrow all considerations, using heuristics to limit the type of needs addressed and the range of services and supports provided. The consequences were a largely reactive, less personalised system of care. The findings emphasise the need for an integrated and comprehensive assessment process that is more concerned with individualised responses rather than relying on existing models of care alone.

scholarly journals Resource allocation decision-making in dementia care with and without budget constraints: a qualitative analysis

2020 ◽  
Vol 3 ◽  
pp. 69
Author(s):  
Fiona Keogh ◽  
Tom Pierse ◽  
Eamon O'Shea ◽  
Christine Fitzgerald ◽  
David Challis
Keyword(s):  
Decision Making ◽  
Resource Allocation ◽  
Budget Constraint ◽  
Dementia Care ◽  
Assessment Process ◽  
Nominal Group ◽  
Dementia Case ◽  
People With Dementia ◽  
Health And Social Care ◽  
Services And Supports

Introduction: Health systems in many different countries have increasingly been reorienting the delivery of dementia care to home and community care settings. This paper provides information on how health and social care professionals (HSCPs) in Ireland make decisions on resource allocation for people with dementia living at home and how resource constraints affect their decisions and choices. Methods: The study employed a balance of care approach to assess resource allocation across six dementia case types, ranging from low to high needs. Decision-making workshops were held with 24 HSCPs from a range of backgrounds. Participants were asked to allocate services and supports across dementia case types in two scenarios: allocation with and without a budget constraint. Nominal group technique was used to structure discussions around resource allocation in both scenarios. Thematic analysis was applied to analyse the qualitative data using a general inductive approach. Results: The following themes influenced allocative deliberations: whose needs are being met; what needs are identified; decision making context; decision making process; and allocation outcomes. Participants used ‘decision rules’ or heuristics to help them make decisions under fixed budget rules. Conclusions: Freedom from a budget constraint allowed HSCPs to consider a broader range of services and to take a more expansive view on what needs should be considered, with a particular emphasis on adopting a proactive, preventative approach to the allocation of resources. The effect of the budget constraint overall was to narrow all considerations, using heuristics to limit the type of needs addressed and the range of services and supports provided. The consequences were a largely reactive, less personalised system of care. The findings emphasise the need for an integrated and comprehensive assessment process that is more concerned with individualised responses rather than relying on existing models of care alone.

scholarly journals Supporting communication in semantic dementia: clinical consensus from expert practitioners

2015 ◽  
Vol 16 (3) ◽  
pp. 153-164 ◽  
Author(s):  
Jacqueline Kindell ◽  
Karen Sage ◽  
Madeline Cruice
Keyword(s):  
Nominal Group Technique ◽  
Research Literature ◽  
Dementia Care ◽  
Semantic Dementia ◽  
Nominal Group ◽  
Content Type ◽  
Modified Delphi ◽  
Client Group ◽  
Health And Social Care ◽  
The Uk

Purpose – The purpose of this paper is to gain consensus regarding the clinical priorities and tasks required in supporting communication needs in those living with semantic dementia and their families, by specialist speech and language therapists (SLTs), working in clinical practice within dementia care settings in the UK. Design/methodology/approach – A nominal group technique was used, followed by further exploration and refinement of issues using a modified Delphi technique with a group of six SLTs who specialised in dementia care and who had experience of working with individuals with semantic dementia and their families. Findings – The findings in the study demonstrate a broader scope of practice than is evident within the research literature with this client group. Therapists identified a range of psychosocial issues for both the person with semantic dementia and their family, in particular finding ways to support activity and participation in conversation and explore barriers and facilitators within the communication environment. Originality/value – This represents the first study to explore everyday practice in this rarer dementia and the information gathered here will be of use to a variety of health and social care professions interested in supporting those with semantic dementia and their families.

EP.TH.602Exploring decision-making of healthcare professionals in patients with benign large non-pedunculated colonic polyps (BLNPCP) virtually using combined focus group and nominal group technique

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
L Wheldon ◽  
J Morgan ◽  
MJ Lee ◽  
S Riley ◽  
SR Brown ◽  
...  
Keyword(s):  
Decision Making ◽  
Healthcare Professional ◽  
Patient Preference ◽  
Healthcare Professionals ◽  
Nominal Group Technique ◽  
Colonic Polyps ◽  
Nominal Group ◽  
Shared Decision ◽  
Patient Factors ◽  
Group Technique

Abstract Aim We aimed to elicit key factors that influence healthcare professional decision-making when deciding treatment for BLNPCP. Background Benign large non-pedunculated colonic polyps (BLNPCP) may harbour covert malignancy and opinions differ about the optimal treatment modality. There are several options available, including endoscopic mucosal resection, endoscopic submucosal resection, combined endoscopic laparoscopic surgery and surgical resection. Despite widespread availability of endoscopic resection techniques, there are high rates of surgery in the UK. Methods Three focus groups of healthcare professionals, comprised of either consultant colorectal surgeons, nurse endoscopists and consultant gastroenterologists, were conducted virtually utilising the Nominal Group Technique. Meetings were recorded and transcribed verbatim. Themes were devolved using the framework approach for qualitative analysis. A priority-ranked list of factors influencing healthcare professional decision-making in this setting was generated. Results Five main themes were identified as influencing decision-making: Shared decision making (patient preference, informed consent); Patient factors (co-morbidity, age, life-expectancy); Polyp factors (Location, size, morphology, risk of cancer); Healthcare professionals (skill-set, personal preference); System factors (techniques availability locally, regional referral networks). Nominal Group Technique generated 55 items across the three focus groups. Nurses and gastroentologists ranked patient factors (particularly drug history and tolerance of procedure) and shared decision making (patient preference) more highly then surgeons. Surgeons placed greater emphasis on polyp factors particularly location and the risk of submucosal invasive carcinoma. Conclusion Decision making is complex and multifactorial. These results support the benefits of complex polyp MDTs and patient involvement in the decision-making. The complexity of decision-making may underpin wide variation in practice.

scholarly journals Community Priority Index: utility, applicability and validation for priority setting in community-based participatory research

2015 ◽  
Vol 4 (2) ◽  
Author(s):  
Hamisu M. Salihu ◽  
Abraham A. Salinas-Miranda ◽  
Wei Wang ◽  
DeAnne Turner ◽  
Estrellita Lo Berry ◽  
...  
Keyword(s):  
Decision Making ◽  
Participatory Research ◽  
Priority Setting ◽  
Nominal Group Technique ◽  
Community Based Participatory Research ◽  
Self Esteem ◽  
Nominal Group ◽  
Community Settings ◽  
Community Based ◽  
Priority Index

<em>Background</em>. Providing practitioners with an intuitive measure for priority setting that can be combined with diverse data collection methods is a necessary step to foster accountability of the decision-making process in community settings. Yet, there is a lack of easy-to-use, but methodologically robust measures, that can be feasibly implemented for reliable decision-making in community settings. To address this important gap in community based participatory research (CBPR), the purpose of this study was to demonstrate the utility, applicability, and validation of a community priority index in a community-based participatory research setting. <br /><em>Design and Methods</em>. Mixed-method study that combined focus groups findings, nominal group technique with six key informants, and the generation of a Community Priority Index (CPI) that integrated community importance, changeability, and target populations. Bootstrapping and simulation were performed for validation. <br /><em>Results</em>. For pregnant mothers, the top three highly important and highly changeable priorities were: stress (CPI=0.85; 95%CI: 0.70, 1.00), lack of affection (CPI=0.87; 95%CI: 0.69, 1.00), and nutritional issues (CPI=0.78; 95%CI: 0.48, 1.00). For non-pregnant women, top priorities were: low health literacy (CPI=0.87; 95%CI: 0.69, 1.00), low educational attainment (CPI=0.78; 95%CI: 0.48, 1.00), and lack of self-esteem (CPI=0.72; 95%CI: 0.44, 1.00). For children and adolescents, the top three priorities were: obesity (CPI=0.88; 95%CI: 0.69, 1.00), low self-esteem (CPI=0.81; 95%CI: 0.69, 0.94), and negative attitudes toward education (CPI=0.75; 95%CI: 0.50, 0.94). <br /><em>Conclusions</em>. This study demonstrates the applicability of the CPI as a simple and intuitive measure for priority setting in CBPR.

scholarly journals 96 Service Priorities for People with Dementia in Ireland: A Mixed Methods Study of Health Care Professionals

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Fiona Keogh ◽  
Tom Pierse ◽  
Eamon O'Shea
Keyword(s):  
Mixed Methods ◽  
Health Care Professionals ◽  
Social Care ◽  
Unmet Need ◽  
Budget Constraint ◽  
Similar Proportion ◽  
People With Dementia ◽  
High Dependency ◽  
Health And Social Care ◽  
Wide Range

Abstract Background Public services for people with dementia living in the community face significant resource constraints. The aims of this study are to identify an optimum mix of services for six dementia case types and to gain a greater understanding of the resource allocation decision making process. Methods Irish datasets were used to identify dementia cases types representing 46% of cases in the datasets. Vignettes were prepared for six case types ranging from low to high dependency and needs. Carers, people with dementia and health and social care professionals (HSCPs) took part in mixed methods workshops. Initial findings for the HSCPs are reported here (N=23). HSCP participants firstly quantitatively identified an optimum care package for a set of six vignettes, then qualitatively discussed the needs and individual case factors that were driving service recommendations. The quantitative exercise was repeated with a budget constraint. The sessions finished with a discussion on service and case prioritisation. Results When no budget constraint is imposed, participants recommended the use of a wide range of services. Home help, in-home respite and day care services comprised 62% of spending in this scenario. When a budget constraint was imposed, participants focused on essential care and reduced services aimed at prevention, quality of life and carer support. Resources were not redistributed between cases (e.g. from low need to higher need cases) as a similar proportion of the budget was allocated to each of the cases in both scenarios. Conclusion People with dementia living in the community and their families have a wide range of health and social care needs. Optimum dementia care packages included a wide range of services to meet these needs. However, a budget constraint resulted in a much narrower range of services with consequent implications in terms of unmet need and a reactive rather than preventive approach to care.

scholarly journals Communicating with library patrons and people with dementia: Tracing an ethic of care in professional communication guidelines

Dementia ◽  
2018 ◽  
Vol 19 (3) ◽  
pp. 899-914
Author(s):  
Nicole K Dalmer ◽  
DG Campbell
Keyword(s):  
Interpersonal Relationships ◽  
Ethic Of Care ◽  
Service Providers ◽  
Information Service ◽  
Dementia Care ◽  
Professional Communication ◽  
Moral Principles ◽  
People With Dementia ◽  
Health And Social Care ◽  
Reference Librarians

In both library reference work and dementia care, communication between personnel and service recipients can be both complex and complicated. Professionals in both fields have therefore developed protocols and standards to assist personnel in handling these interactions. In this article we detail an exploratory comparative study that used an ethic of care framework to compare prominent guidelines for reference librarians (American Library Association’s Reference and User Services Association’s Guidelines for behavioral performance of reference and information service providers) with guidelines for workers in long-term dementia care settings (the National Institute for Health and Care Excellence’s Guideline on supporting people with dementia and their carers in health and social care). We explored how both sets of Guidelines frame the act of communication as a combination of regulated procedure and empathetic discourse to determine how the similarities among and differences between these two guidelines provide useful insights into each other. Our examination was structured using an ethic of care lens, which emphasizes the importance of interpersonal relationships, reciprocity, and empathetic benevolence. Using specific phrases in each set of Guidelines that align with and are evidence of Tronto’s four moral principles of care, we ultimately discovered, in both sets of Guidelines, an underlying ethic of care: a repeated insistence upon embedding procedures within behaviour that manifests attentiveness, responsibility, responsiveness, and competence.

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