scholarly journals The Year of Care approach: developing a model and delivery programme for care and support planning in long term conditions

2019 ◽  
Author(s):  
Sue Roberts ◽  
Simon Eaton ◽  
Tracy Finch ◽  
Nick Lewis-Barned ◽  
Monique Lhussier ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Professionals ◽  
Health Behaviours ◽  
Local Health ◽  
Implementation Framework ◽  
Long Term Conditions ◽  
Training Support ◽  
Care And Support ◽  
Health Communities

Abstract Background: People with long term conditions (LTCs) make most of the daily decisions and carry out the activities which affect their health and quality of life. Only a fraction of each contact with a health care professional (HCP) is spent supporting this. This paper describes how care and support planning (CSP) and an implementation framework to redesign services, were developed to address this in UK general practice. Focussed on what is important to each individual, CSP brings together traditional clinical issues and the person’s lived experience in a solution focussed, forward looking conversation with an emphasis on ‘people not diseases’. Methods: The components of CSP were developed in three health communities using diabetes as an exemplar. This model was extended and refined for other single conditions and multimorbidity across 40 sites and two nations, over 15 years. Working with local teams and communities the authors used theoretical models of care, implementation and spread, developing and tailoring training, support and resources to embed CSP as usual care, sharing learning across a community of practice. Results: The purpose, content, process, developmental hurdles and impact of this CSP model are described, alongside an implementation strategy. There is now a robust, reproducible five step model; preparation, conversation, recording, actions and review. Uniquely, preparation, involving information sharing with time for reflection, enables an uncluttered conversation with a professional focussed on what is important to each person. The components of the Year of Care House act as a checklist for implementation, a metaphor for their interdependence and a flexible framework. Spreading CSP involved developing exemplar practices and building capacity across local health communities. These reported improved patient experience, practitioner job satisfaction, health behaviours and outcomes, teamwork, practice organisation, resource use, and links with wider community activities. Conclusions: Tested in multiple settings, CSP is a reproducible and practical model of planned care applicable to all LTCs, with the capacity to be transformative for people with LTCs and health care professionals. It recaptures relational dimensions of care with transactional elements in the background. Options for applying this model and implementation framework at scale now need to be explored.

scholarly journals The Year of Care approach: developing a model and delivery programme for care and support planning in long term conditions within general practice

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Sue Roberts ◽  
Simon Eaton ◽  
Tracy Finch ◽  
Nick Lewis-Barned ◽  
Monique Lhussier ◽  
...  
Keyword(s):  
Health Care ◽  
General Practice ◽  
Health Care Professionals ◽  
Local Health ◽  
Implementation Framework ◽  
Long Term Conditions ◽  
Training Support ◽  
Care And Support ◽  
Health Communities

Abstract Background People with long term conditions (LTCs) make most of the daily decisions and carry out the activities which affect their health and quality of life. Only a fraction of each contact with a health care professional (HCP) is spent supporting this. This paper describes how care and support planning (CSP) and an implementation framework to redesign services, were developed to address this in UK general practice. Focussed on what is important to each individual, CSP brings together traditional clinical issues and the person’s lived experience in a solution focussed, forward looking conversation with an emphasis on ‘people not diseases’. Methods The components of CSP were developed in three health communities using diabetes as an exemplar. This model was extended and refined for other single conditions and multimorbidity across 40 sites and two nations, over 15 years. Working with local teams and communities the authors used theoretical models of care, implementation and spread, developing and tailoring training, support and resources to embed CSP as usual care, sharing learning across a community of practice. Results The purpose, content, process, developmental hurdles and impact of this CSP model are described, alongside an implementation strategy. There is now a robust, reproducible five step model; preparation, conversation, recording, actions and review. Uniquely, preparation, involving information sharing with time for reflection, enables an uncluttered conversation with a professional focussed on what is important to each person. The components of the Year of Care House act as a checklist for implementation, a metaphor for their interdependence and a flexible framework. Spreading CSP involved developing exemplar practices and building capacity across local health communities. These reported improved patient experience, practitioner job satisfaction, health behaviours and outcomes, teamwork, practice organisation, resource use, and links with wider community activities. Conclusions Tested in multiple settings, CSP is a reproducible and practical model of planned care applicable to all LTCs, with the capacity to be transformative for people with LTCs and health care professionals. It recaptures relational dimensions of care with transactional elements in the background. Options for applying this model and implementation framework at scale now need to be explored.

scholarly journals The Year of Care approach: developing a model and delivery programme for care and support planning in long term conditions within general practice

2019 ◽  
Author(s):  
Sue Roberts ◽  
Simon Eaton ◽  
Tracy Finch ◽  
Nick Lewis-Barned ◽  
Monique Lhussier ◽  
...  
Keyword(s):  
Health Care ◽  
General Practice ◽  
Health Care Professionals ◽  
Local Health ◽  
Implementation Framework ◽  
Long Term Conditions ◽  
Training Support ◽  
Care And Support ◽  
Health Communities

Abstract Background: People with long term conditions (LTCs) make most of the daily decisions and carry out the activities which affect their health and quality of life. Only a fraction of each contact with a health care professional (HCP) is spent supporting this. This paper describes how care and support planning (CSP) and an implementation framework to redesign services, were developed to address this in UK general practice. Focussed on what is important to each individual, CSP brings together traditional clinical issues and the person’s lived experience in a solution focussed, forward looking conversation with an emphasis on ‘people not diseases’. Methods: The components of CSP were developed in three health communities using diabetes as an exemplar. This model was extended and refined for other single conditions and multimorbidity across 40 sites and two nations, over 15 years. Working with local teams and communities the authors used theoretical models of care, implementation and spread, developing and tailoring training, support and resources to embed CSP as usual care, sharing learning across a community of practice. Results: The purpose, content, process, developmental hurdles and impact of this CSP model are described, alongside an implementation strategy. There is now a robust, reproducible five step model; preparation, conversation, recording, actions and review. Uniquely, preparation, involving information sharing with time for reflection, enables an uncluttered conversation with a professional focussed on what is important to each person. The components of the Year of Care House act as a checklist for implementation, a metaphor for their interdependence and a flexible framework. Spreading CSP involved developing exemplar practices and building capacity across local health communities. These reported improved patient experience, practitioner job satisfaction, health behaviours and outcomes, teamwork, practice organisation, resource use, and links with wider community activities. Conclusions: Tested in multiple settings, CSP is a reproducible and practical model of planned care applicable to all LTCs, with the capacity to be transformative for people with LTCs and health care professionals. It recaptures relational dimensions of care with transactional elements in the background. Options for applying this model and implementation framework at scale now need to be explored.

scholarly journals Long-term condition management: health professionals’ perspectives

2011 ◽  
Vol 3 (1) ◽  
pp. 16 ◽  
Author(s):  
Natasha Ashworth ◽  
Shona Thompson
Keyword(s):  
Primary Care ◽  
Health Care ◽  
New Zealand ◽  
Health Professionals ◽  
Health Care Professionals ◽  
Service Development ◽  
Health Board ◽  
Long Term Conditions ◽  
Family Nursing

INTRODUCTION: Long-term conditions (LTCs) are the leading cause of morbidity and mortality in New Zealand. The burden upon patients and health care services to manage these conditions has prompted calls for primary care to lead the way in early diagnosis and coordination of LTC care. The purpose of this study was to investigate the perspectives of health professionals in a geographically-isolated region of New Zealand regarding current levels of LTC management to provide direction for future service development. METHODS: Semi-structured, face-to-face interviews conducted in 2009 with 10 purposively sampled health professionals in the primary care field, including four general practitioners, four nurses and two management team personnel, all practising in a regional District Health Board. The resultant data were analysed using a general inductive thematic approach. FINDINGS: Three main themes were identified by the health professionals as being key issues pertaining to the management of LTCs. These are discussed as issues pertaining to management, information and communication and leadership. CONCLUSION: The results showed that LTC management is rated as highly important by health care professionals who are aware of the need to change current delivery methods to improve client outcomes. All those interviewed highlighted issues related to funding as being a significant barrier to implementing innovations in LTC management, including nurse-led services. Plans to develop integrated family health centres, information technology systems and increased collaboration between clinicians were hailed as potential solutions to improving LTC management. KEYWORDS: Chronic disease; family nursing; family practice; nurse led clinics; nurse’s practice patterns

scholarly journals Adapting the definition of multimorbidity – development of a locality-based consensus for selecting included Long Term Conditions

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Nasrin Hafezparast ◽  
Ellie Bragan Turner ◽  
Rupert Dunbar-Rees ◽  
Alice Vodden ◽  
Hiten Dodhia ◽  
...  
Keyword(s):  
Literature Review ◽  
Selection Process ◽  
Final Decision ◽  
Local Health ◽  
Urban Context ◽  
Long Term Conditions ◽  
Large Cities ◽  
Second Stage ◽  
Local Health Service

Abstract Background Defining multimorbidity has proved elusive in spite of attempts to standardise definitions. For national studies, a broad definition is required to capture national diversity. For locally based studies, the definition may need to reflect demographic and morbidity patterns. We aimed to define multimorbidity for an inner city, multi-ethnic, deprived, young age community typical of many large cities. Methods We used a scoping literature review to identify the international literature, standards and guidelines on Long Term Condition (LTC) definitions for inclusion in our multimorbidity definition. Consensus was categorised into high, medium or low consensus, depending on the number of literature sources citing each LTC. Findings were presented to a workshop consisting of local health service stakeholders who were asked to select LTCs for inclusion in a second stage review. In the second stage, each LTC was tested against seven evaluation domains: prevalence, impact, preventability, treatment burden, progression to multiple LTCs, impact on younger people, data quality. These domains were used to create 12 target criteria. LTC rankings according to consensus group and target criteria scores were presented to a second workshop for a final decision about LTC inclusion. Results The literature review identified 18 literature sources citing 86 LTCs: 11 were excluded because they were LTC clusters. The remainder were allocated into consensus groupings: 13 LTCs were ‘high consensus’ (cited by ≥ 11 sources); 15 were ‘medium consensus’ (cited by 5–10 sources); 47 were ‘low consensus’ (cited by < 5 sources). The first workshop excluded 31 LTCs. The remaining 44 LTCs consisted of: 13 high consensus LTCs, all with high target score (score 6–12); 15 medium consensus LTCs, 11 with high target scores; 16 low consensus LTCs, 6 with high target scores. The final workshop selected the 12 high consensus conditions, 12 medium consensus LTCs (10 with high target scores) and 8 low consensus LTCs (3 with high target scores), producing a final selection of 32 LTCs. Conclusions Redefining multimorbidity for an urban context ensures local relevance but may diminish national generalisability. We describe a detailed LTC selection process which should be generalisable to other contexts, both local and national.

scholarly journals Health care network for chronic conditions: an intervention and evaluation in the health system

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
C S Cardoso ◽  
N R Baldoni ◽  
C F Melo ◽  
L O Rezende ◽  
K Noronha ◽  
...  
Keyword(s):  
Health Care ◽  
Health System ◽  
Health Care Professionals ◽  
Chronic Conditions ◽  
Panel Study ◽  
Health Indicators ◽  
Institutional Capacity ◽  
Local Health ◽  
Care Network ◽  
Health Care Network

Abstract Background Health assessments are necessary for the (re) formulation of effective public policies and to guarantee the quality of care offered. This study aim to evaluate the perception of health professionals concerning the institutional capacity of the health system to care for Chronic Conditions (CC) after intervention in a medium-sized municipality in Minas Gerais, Brazil. Methods It is a panel study with evaluation before, during and after an intervention in the health system with a focus on three CC, i.e., i) diabetes; ii) hypertension; and iii) pregnant women. Health care professionals from primary and specialized care units were interviewed using the Assessment of Chronic Illness Care (ACIC) scale, which was applied in nine focal groups organized by health care unit. Results A total of 240 professionals participated of this evaluation, being 94, 63 and 82 participants in 2013, 2015 and 2018 respectively. The ACIC scores showed an positive evolution in the capacity of the health system to care for CC over the years. In the first wave the global score was 5.40 (basic capacity), while in the third wave the score was 9.38 (optimal capacity), with a significant increase in the scores (p &lt; 0.01). Conclusions An important gain in the institutional capacity of the municipality was evidenced for the care of chronic conditions after intervention in the health system. Such an enhancement of the health system to operate in the CC might be sustainable over the time. Furthermore, its impact may directly reflect on the health indicators of the population. Key messages The results showed a strengthening of the local health system. These findings can subsidize other municipalities with a similar reality in the organization of the health care network and, consequently improve the care provided to chronic conditions.

Building Health Communities: Local Health Care Networks in Maryland

2019 ◽  
Vol 50 (1) ◽  
pp. 62-76 ◽  
Author(s):  
Aaron Wachhaus
Keyword(s):  
Health Care ◽  
Local Level ◽  
Collaborative Networks ◽  
Local Health ◽  
Exploratory Research ◽  
The Public ◽  
Health Care Networks ◽  
Local Health Care ◽  
Health Communities ◽  
Treatment Of Obesity

Combatting chronic disease (prevention and treatment of obesity, diabetes, heart health, and stroke) requires action at the local level, both to educate the public and to provide health services. Effective collaboration among local organizations devoted to educating the public about, and treating patients of, these diseases is a key component of successful health care. To better understand local efforts, a social network analysis of five local health care networks spanning eight counties in Maryland was conducted. The purpose of this exploratory research was to discover whether collaborative networks exist at the local level, to map the networks, and to assess their strengths and needs.

Sport Concussion Education and Prevention

2012 ◽  
Vol 6 (3) ◽  
pp. 293-301 ◽  
Author(s):  
Charles H. Tator
Keyword(s):  
Health Care ◽  
Health Care Professionals ◽  
Educational Strategies ◽  
Short Term ◽  
Sports Organizations ◽  
Sport Concussion ◽  
Data Collection Program ◽  
Collection Program ◽  
Concussion Education

There has been a remarkable increase in the past 10 years in the awareness of concussion in the sports and recreation communities. Just as sport participants, their families, coaches, trainers, and sports organizations now know more about concussions, health care professionals are also better prepared to diagnose and manage concussions. As has been stated in the formal articles in this special issue on sport-related concussion, education about concussion is one of the most important aspects of concussion prevention, with the others being data collection, program evaluation, improved engineering, and introduction and enforcement of rules. Unfortunately, the incidence of concussion appears to be rising in many sports and thus, additional sports-specific strategies are required to reduce the incidence, short-term effects, and long term consequences of concussion. Enhanced educational strategies are required to ensure that individual participants, sports organizations, and health care professionals recognize concussions and manage them proficiently according to internationally recognized guidelines. Therefore, this paper serves as a “brief report” on a few important aspects of concussion education and prevention.

scholarly journals Making the Transition to Insulin Therapy: The Experiences of Samoan People with Type 2 Diabetes in New Zealand

2021 ◽  
Author(s):  
◽  
Sera Tapu-Ta'ala
Keyword(s):  
Type 2 Diabetes ◽  
Health Care ◽  
New Zealand ◽  
Insulin Therapy ◽  
Health Care Professionals ◽  
Pacific People ◽  
Qualitative Descriptive

<p>Background Pacific people are dying younger compared to other New Zealanders because of complications resulting from uncontrolled type 2 diabetes mellitus. Good diabetes control is achievable with early use of insulin because of its effectiveness, and proven long term benefits to quality of life. An understanding of how Samoan people with type 2 diabetes make their transition to insulin therapy will assist in understanding how insulin is perceived, which will inform health care professionals in their work with those diagnosed with diabetes. Aim of Research The aim of the research is to explore and describe how Samoan people with type 2 diabetes in New Zealand made the transition to insulin therapy for better glycaemic control. Design The Fonofale Model was used as the theoretical framework, from which to understand Samoan peoples' experiences. This research used a qualitative descriptive methodology. In-depth interviews were used to gather the stories of four Samoan participants over the age of 18 years diagnosed with type 2 diabetes. The data was analysed using thematic analysis. Findings Three major themes emerged from the analysis of the participants' stories. These were: living with diabetes, making the transition to insulin therapy and realisation. The findings led to the creation of the Ia Malu model, which describes the experiences of the participants in this study. Conclusion This study confirmed that there are immense challenges and struggles encountered by people with diabetes. Their adjustment to the illness as well as making the transition to using insulin takes time. As a result of this, it is fundamental for nurses/health care professionals to understand that this is the reality for these people, and they must therefore provide time for people to adjust.</p>

The personal experience of cancer

2007 ◽  
pp. 79-98
Keyword(s):  
Health Care ◽  
Health Policy ◽  
Health Services ◽  
Health Care Professionals ◽  
Service User ◽  
Fear Of Recurrence ◽  
Local Health ◽  
Government Health ◽  
The Uk ◽  
Living With Cancer

Introduction 80 The cancer journey 82 Calendars 84 Diagnosis 86 Reactions to diagnosis and treatment 88 Living with cancer 90 Fear of recurrence 92 Recurrence and facing death 94 Survivorship 96 Government health policy in the UK aims to put the patient, or service user, at the heart of local health services. For this to happen, health care professionals must gain an appreciation of what it is like to be a person with cancer, or a carer of someone with cancer. It is hard to know or understand the experience of another person, but there are various ways that we can gain insights into their experience. This section reviews ways of understanding the experience of cancer, and then goes on to look at different aspects of that experience for individuals, using the words of people with cancer....

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