InFORM: Improving care for people who Frequently call 999: co-production of guidance through an Observational study using Routine linked data and Mixed methods

BackgroundPeople who frequently call the 999 ambulance service present an operational challenge to providers and their needs are inadequately met by current service provision. Aim of researchTo understand patterns and health outcomes of frequent calling and to work with stakeholders to co-produce guidance for formal testing in a future evaluation. MethodsThis mixed methods study will include a scoping review of national and international literature followed by an epidemiological study of callers at the all Wales level exploring health outcomes through anonymised linked data. We will also explore the views of patients using qualitative Bio-photographic interview method with a follow up interview at six months and use focus groups with care providers from across primary and emergency care and the third sector. We will use generalised linear model to analyse quantitative data and qualitative data will be analysed thematically. ResultsFindings will include follow up of eligible patients; successful data matching and data linkage; retrieval of outcomes within 12 months. Outcomes will include: adverse events, deaths, emergency admissions; 999 attendances. Qualitative results will include Bio-photographic interviews with completed scrap books and interviews based on the books (n=34). Care provider focus groups (n= 22). Output Co-produced guidance developed with stakeholders. ConclusionHigh users of the 999-ambulance represent a significant policy challenge to emergency ambulance services and often present with complex needs. This study will inform on the characteristics of callers and how to address their care supported with a co-produced guidance for care providers.

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What makes palliative care needs “complex”? A multisite sequential explanatory mixed methods study of patients referred for specialist palliative care

BMC Palliative Care ◽

10.1186/s12904-020-00700-3 ◽

2021 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Anne M. Finucane ◽

Connie Swenson ◽

John I. MacArtney ◽

Rachel Perry ◽

Hazel Lamberton ◽

...

Keyword(s):

Palliative Care ◽

Focus Groups ◽

Healthcare Professionals ◽

Psychological Needs ◽

Care Providers ◽

Specialist Palliative Care ◽

Care Needs ◽

Complex Needs ◽

Sequential Explanatory ◽

Palliative Care Needs

Abstract Background Specialist palliative care (SPC) providers tend to use the term ‘complex’ to refer to the needs of patients who require SPC. However, little is known about complex needs on first referral to a SPC service. We examined which needs are present and sought the perspectives of healthcare professionals on the complexity of need on referral to a hospice service. Methods Multi-site sequential explanatory mixed method study consisting of a case-note review and focus groups with healthcare professionals in four UK hospices. Results Documentation relating to 239 new patient referrals to hospice was reviewed; and focus groups involving 22 healthcare professionals conducted. Most patients had two or more needs documented on referral (96%); and needs were recorded across two or more domains for 62%. Physical needs were recorded for 91% of patients; psychological needs were recorded for 59%. Spiritual needs were rarely documented. Referral forms were considered limited for capturing complex needs. Referrals were perceived to be influenced by the experience and confidence of the referrer and the local resource available to meet palliative care needs directly. Conclusions Complexity was hard to detail or to objectively define on referral documentation alone. It appeared to be a term used to describe patients whom primary or secondary care providers felt needed SPC knowledge or support to meet their needs. Hospices need to provide greater clarity regarding who should be referred, when and for what purpose. Education and training in palliative care for primary care nurses and doctors and hospital clinicians could reduce the need for referral and help ensure that hospices are available to those most in need of SPC input.

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How to Make Online Mood-monitoring in Bipolar Patients a Success? A Qualitative Exploration of Requirements.

10.21203/rs.3.rs-757613/v1 ◽

2021 ◽

Author(s):

Bart Geerling ◽

Saskia M. Kelders ◽

Ralph W. Kupka ◽

Anja W.W.M. Stevens ◽

Ernst T. Bohlmeijer

Keyword(s):

Early Intervention ◽

Focus Groups ◽

Intervention Strategies ◽

Care Providers ◽

Successful Design ◽

Technical Features ◽

Bipolar Patients ◽

Qualitative Exploration ◽

Monitoring Application

Abstract Background The Life-Chart Method (LCM) is an effective self-management treatment option in bipolar disorder (BD). There is insufficient knowledge about the consumers' needs and desires for an e-monitoring solution. The first step towards a new mood monitoring application is an extended inventory among consumers and professionals.BackgroundThe aim of the current study was: to identify opinions about online mood monitoring of patients with BD and professionals and to identify preferences on design, technical features and options facilitating optimal use and implementation of online mood monitoring.This study used a qualitative design with focus groups. Participants were recruited among patients and care providers. Three focus groups were held with eight consumers and five professionals. ResultsThe focus group meetings reveal a shared consciousness of the importance of using the Life-Chart Method for online mood monitoring. There is a need for personalization, adjustability, a strict privacy concept, an adjustable graphic report, and a link to early intervention strategies in the design. Due to the fact that this is a qualitative study with a relative small number of participants, so it remains unclear whether the results are fully generalizable. We can’t rule out a selection bias.Conclusions This study demonstrates the importance of involving stakeholders in identifying a smartphone-based mood charting applications' requirements. Personalization, adjustability, privacy, an adjustable graphic report, and a direct link to early intervention strategies are necessary requirements for a successful design. The results of this value specification are included in the follow-up of this project.

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PP24 Time: take-home naloxone in multicentre emergency settings: protocol for a feasibility study

Emergency Medicine Journal ◽

10.1136/emermed-2019-999.24 ◽

2019 ◽

Vol 36 (1) ◽

pp. e10.1-e10

Author(s):

Matthew Jones ◽

Helen Snooks ◽

Jenna Bulger ◽

Alan Watkins ◽

Chris Moore ◽

...

Keyword(s):

Feasibility Study ◽

Linked Data ◽

Cost Effective ◽

Feasibility Trial ◽

Adverse Event Rate ◽

Opioid Overdose ◽

Opioid Agonist ◽

Data Matching ◽

The Uk

BackgroundOpioids such as heroin kill more people worldwide than any other drug. Death rates associated with opioid poisoning in the UK are at record levels. Naloxone is an opioid agonist which can be distributed in take home ‘kits’. This intervention is known as Take Home Naloxone (THN).MethodsWe propose to carry out a randomised controlled feasibility trial (RCT) of THN distributed in emergency settings clustered by Emergency Department (ED) catchment area, and local ambulance service; with anonymised linked data outcomes. This will include distribution of THN by paramedics and ED staff to patients at risk of opioid overdose. Existing linked data will be used to develop a discriminant function to retrospectively identify people at high risk of overdose death based on observable predictors of overdose to include in outcome follow up.ResultsWe will gather outcomes up to one year including; deaths (and drug related); emergency admissions; intensive care admissions; ED attendances (and overdose related); 999 attendances (and for overdose); THN kits issued; and NHS resource usage. We will agree progression criteria following consultation with research team members related to sign up of sites; successful identification and provision of THN to eligible participants; successful follow up of eligible participants and opioid decedents; adverse event rate; successful data matching and data linkage; and retrieval of outcomes within three months of projected timeline.ConclusionsTHN programmes are currently run by some drug services in the UK. However, saturation is low. There has been a lack of experimental research in to THN, and so questions remain: Does THN reduce deaths? Are there unforeseen harms associated with THN? Is THN cost effective? This feasibility study will establish whether a fully powered cluster RCT can be used to answer these questions.

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Quality and barriers of outpatient diabetes care in rural health facilities in Uganda – a mixed methods study

BMC Health Services Research ◽

10.1186/s12913-019-4535-x ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Catherine Birabwa ◽

Mulekya F. Bwambale ◽

Peter Waiswa ◽

Roy W. Mayega

Keyword(s):

Blood Pressure ◽

Quality Of Care ◽

Mixed Methods ◽

Blood Glucose ◽

Health Outcomes ◽

Diabetes Care ◽

Blood Cholesterol ◽

Care Process ◽

Care Providers

Abstract Background Despite the increasing burden of diabetes in Uganda, little is known about the quality of type 2 diabetes mellitus (T2DM) care especially in rural areas. Poor quality of care is a serious limitation to the control of diabetes and its complications. This study assessed the quality of care and barriers to service delivery in two rural districts in Eastern Uganda. Methods This was a mixed methods cross-sectional study, conducted in six facilities. A randomly selected sample of 377 people with diabetes was interviewed using a pre-tested interviewer administered questionnaire. Key informant interviews were also conducted with diabetes care providers. Data was collected on health outcomes, processes of care and foundations for high quality health systems. The study included three health outcomes, six elements of competent care under processes and 16 elements of tools/resources and workforce under foundations. Descriptive statistics were computed to determine performance under each domain, and thematic content analysis was used for qualitative data. Results The mean age of participants was 49 years (±11.7 years) with a median duration of diabetes of 4 years (inter-quartile range = 2.7 years). The overall facility readiness score was 73.9%. Inadequacies were found in health worker training in standard diabetes care, availability of medicines, and management systems for services. These were also the key barriers to provision and access to care in addition to lack of affordability. Screening of clients for blood cholesterol and microvascular complications was very low. Regarding outcomes; 56.8% of participants had controlled blood glucose, 49.3% had controlled blood pressure; and 84.0% reported having at least one complication. Conclusion The quality of T2DM care provided in these rural facilities is sub-optimal, especially the process of care. The consequences include sub-optimal blood glucose and blood pressure control. Improving availability of essential medicines and basic technologies and competence of health workers can improve the care process leading to better outcomes.

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Factors associated with knowledge of where to access health care among youth in juvenile detention: a mixed methods study

International Journal of Adolescent Medicine and Health ◽

10.1515/ijamh-2018-0128 ◽

2019 ◽

Vol 0 (0) ◽

Cited By ~ 1

Author(s):

Titilola Balogun ◽

Catherine Troisi ◽

Michael D. Swartz ◽

Linda Lloyd ◽

Rebecca Beyda

Keyword(s):

Primary Care ◽

Health Care ◽

Substance Use ◽

Mixed Methods ◽

General Population ◽

Health Outcomes ◽

Health Issues ◽

Care Providers ◽

Health Concerns ◽

Factors Associated

Abstract Background Mental illness, substance use, and sexual health issues are major health concerns among detained youth compared with the general population. There is a dearth of studies that demonstrate what detained youth in the United States know about where to access health services in the community. Given the magnitude of these health concerns among detained youth compared with youth in the general population, knowing where to access health care in the community could lead to early intervention and better health outcomes. Objectives This study determines what detained youth know about where to access care for mental health symptoms, substance use, and sexually transmitted infections, and identifies the factors associated with knowledge of where to access health care. Methods Data were collected using mixed methods from a cross-sectional sample of 301 detained youth. Information was obtained using surveys (which included closed and open-ended questions), and data abstraction from their medical records. Logistic regression analysis, Chi-squared tests and thematic analysis were used to analyze the data. Results Having a primary care provider, perceived susceptibility, and previous experiences with health care providers all influenced what youth in our study knew about where to seek health care. Conclusions The use of mixed methods including open-ended questions allowed us to gain a better perspective of where detained youth would seek help for health issues. Detained youth have poorer health outcomes yet many did not know where to access health resources. Primary care providers who see youth should provide comprehensive, youth-friendly services.

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Scaling up pediatric nurse specialist education in Ghana – a longitudinal, mixed methods evaluation

BMC Nursing ◽

10.1186/s12912-021-00550-1 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Roxana Salehi ◽

Augustine Asamoah ◽

Stephanie de Young ◽

Hannah Acquah ◽

Nikhil Agarwal ◽

...

Keyword(s):

Mixed Methods ◽

Focus Groups ◽

Training Program ◽

Clinical Skills ◽

Scaling Up ◽

Nurse Training ◽

Program Outcomes ◽

Pediatric Nursing ◽

Pediatric Nurse

Abstract Background Inadequate health human resources is a key challenge to advancing child survival in Ghana. Nurses are an essential human resource to target because they represent the largest portion of the health workforce. Building on lessons learned from our pilot pediatric nurse training project and World Health Organization guidelines for transforming and scaling up health professional education, this project aimed to; train 500 pediatric nurse specialists through a one-year training program; develop and integrate a critical mass of pediatric nursing faculty and establish a national standardized pediatric nursing curriculum. This study aimed to evaluate the effectiveness of a national pediatric nurse training program in Ghana at the end of 4 years, including eight cohorts with 330 graduates. Methods This was a mixed-method evaluation with surveys, focus groups and a pre-test/post-test design. Before and after surveys were used to measure knowledge and confidence at baseline and graduation. Objective Structured Clinical Examinations (OSCE) were used to measure clinical skills at baseline, graduation, and 14 months follow-up. At the end of every module, surveys were used to measure students’ satisfaction. Focus groups at graduation qualitatively measured program outcomes. Repeat focus groups and surveys at 14 months after graduation captured the graduates’ career progress, experiences reintegrating into the health system and long-term program outcomes. Results Overall, the graduates completed the program with significantly increased knowledge, confidence, and clinical skills. They also had increased job satisfaction and were able to apply what they learned to their jobs, including leadership skills and gender-sensitive care. Data from 14-month follow-up OSCEs showed that all graduates remained competent in communication, physical assessment, and emergency care, although some obtained a lower mark compared to their performance at graduation. This finding is linked with the observation that the amount of mentorship, support from leadership and equipment that the graduates accessed from their respective facilities varied. Conclusions Mixed-methods evaluations demonstrated significant increases in knowledge confidence and skills by completing the program and maintenance of skills more than 1 year after graduation. Findings have implications for those working on the design, implementation, and evaluation of nursing education interventions in low- and middle-income countries.

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What Makes Palliative Care Needs “Complex”?: A Multisite Sequential Explanatory Mixed Methods Study of Patients Referred to Specialist Palliative Care

10.21203/rs.3.rs-99020/v1 ◽

2020 ◽

Author(s):

Anne Finucane ◽

Connie Swenson ◽

John I MacArtney ◽

Rachel Perry ◽

Hazel Lamberton ◽

...

Keyword(s):

Palliative Care ◽

Focus Groups ◽

Healthcare Professionals ◽

Psychological Needs ◽

Care Providers ◽

Specialist Palliative Care ◽

Care Needs ◽

Complex Needs ◽

Sequential Explanatory ◽

Palliative Care Needs

Abstract Background: Specialist palliative care (SPC) providers tend to use the term ‘complex need’ to refer to the needs of patients who require SPC. However, little is known about “complex needs” on first referral to a SPC service. We examined which needs are present and sought the perspectives of healthcare professionals on the complexity of need on first referral to a hospice service. Methods: Multi-site sequential explanatory mixed method study consisting of a case-note review and focus groups with healthcare professionals in four UK hospices. Results: Documentation relating to 239 new patient referrals to hospice was reviewed; and focus groups involving 22 healthcare professionals conducted. Most patients had two or more needs documented on referral (96%); and needs were recorded across two or more domains for 62%. Physical needs were recorded for 91% of patients; psychological needs were recorded for 59%. Spiritual needs were rarely documented. Referral forms were considered limited for capturing complex needs. Referrals were perceived as influenced by the experience and confidence of the referrer and the local resource available to meet palliative care needs directly.Conclusions: Complexity was hard to detail or to objectively define on referral documentation alone. It appeared to be a term used to describe patients whom primary or secondary care providers felt needed specialist palliative care knowledge or support to meet their needs. Education and training in palliative care for primary care nurses and doctors and hospital clinicians could reduce the need for referral and help ensure that hospices are available to those most in need of specialist palliative care input.

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Development and Pilot Testing of Text Messages to Reduce Sugar-Sweetened Beverage Intake in Rural Caregivers and Adolescents: A Mixed-Methods Study (Preprint)

10.2196/preprints.14785 ◽

2019 ◽

Author(s):

Maryam Yuhas ◽

Kathleen Joyce Porter ◽

Donna-Jean Brock ◽

Annie Loyd ◽

Brittany Alexandra McCormick ◽

...

Keyword(s):

Mixed Methods ◽

Focus Groups ◽

Pilot Trial ◽

Text Message ◽

Text Messages ◽

Utilization Rate ◽

Rural Caregivers ◽

Message Development ◽

Caregiver Behaviors

BACKGROUND High consumption of sugar-sweetened beverages (SSB) poses significant health concerns, particularly for rural adults and adolescents. Developing innovative strategies that target caregivers as the agents of change could be a promising way to improve both caregiver and adolescent health. Sending text messages through mobile phones has been cited as an effective way to improve behavioral outcomes, although little research has been conducted in rural areas, particularly focusing on SSB intake. OBJECTIVE Targeting rural caregivers, the objectives of this two phase study were to: 1) understand caregivers’ perceptions and language preferences for SSB-related text messages to inform and refine message development and delivery, and 2) evaluate the acceptability of text messages for SSB behavior change, and examine short-term effects on SSB behaviors. METHODS A convergent mixed-methods design was used to systematically develop and pilot test text messages with caregivers in Southwest Virginia. In phase one, five focus groups that included a card-sorting activity were conducted to explore advantages/disadvantages, language preferences (i.e., tone of voice, audience, phrase preferences), and perceived use of text messages. In phase two, caregivers participated in a 5-week text message pilot trial that included weekly educational and personalized strategy messages and SSB assessments at baseline and follow-up. Before the focus groups and after completing the pilot trial, caregivers also completed a pre-post survey that assessed SSB intake, SSB home availability, and caregiver SSB-related practices. Caregivers also completed individual follow-up telephone interviews following the pilot trial. RESULTS In phase one, caregivers (n=33) reported that text messages were convenient, accessible, and easy to read. Additionally, caregivers preferred messages with empathetic and authoritative tones of voice that provided useful strategies and stayed away from using absolute words (e.g., always, never). In the phase two pilot trial (n=30), 87% of caregivers completed baseline and 77% completed follow-up assessment suggesting a high utilization rate. Other ways caregivers reported benefiting from the text messages included sharing messages with family members, friends, and coworkers (80%), making mental notes (57%), and looking back at messages as reminders (50%). Caregivers reported significant improvements in home environment, parenting practices, and rulemaking around SSB (all P <0.05). Also, the frequency of SSB intake among caregivers and adolescents significantly decreased (P <0.01). CONCLUSIONS Spending time in the formative phases of text message development helped to understand the unique perspectives and language preferences of the target population. This study also found that delivering an intervention through text messages has the potential to improve caregiver behaviors and reduce SSB intake in rural caregivers and adolescents. Findings from this study were used to develop a larger bank of text messages, which will be used in a future study testing the effectiveness of a text message intervention targeting SSB-related caregiver behaviors.

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Development and Pilot Testing of Text Messages to Help Reduce Sugar-Sweetened Beverage Intake Among Rural Caregivers and Adolescents: Mixed Methods Study

JMIR mhealth and uhealth ◽

10.2196/14785 ◽

2019 ◽

Vol 7 (7) ◽

pp. e14785

Author(s):

Maryam Yuhas ◽

Kathleen J Porter ◽

Donna-Jean P Brock ◽

Annie Loyd ◽

Brittany A McCormick ◽

...

Keyword(s):

Mixed Methods ◽

Focus Groups ◽

Phase 1 ◽

Pilot Trial ◽

Text Message ◽

Text Messages ◽

Phase 2 ◽

Rural Caregivers ◽

Caregiver Behaviors

Background A high consumption of sugar-sweetened beverages (SSBs) poses significant health concerns, particularly for rural adults and adolescents. A manner in which the health of both caregivers and adolescents can be improved is by developing innovative strategies that target caregivers as the agents of change. Sending text messages through mobile phones has been cited as an effective way to improve behavioral outcomes, although little research has been conducted in rural areas, particularly focusing on SSB intake. Objective By targeting rural caregivers, this 2-phase study aimed to (1) understand caregivers’ perceptions and language preferences for SSB-related text messages to inform and refine message development and delivery and (2) evaluate the acceptability of text messages for SSB intake behavior change and examine short-term effects on SSB intake behavior. Methods A convergent mixed methods design was used to systematically develop and pilot-test text messages with caregivers in Southwest Virginia. In phase 1, 5 focus groups that included a card-sorting activity were conducted to explore advantages/disadvantages, language preferences (ie, tone of voice, audience, and phrase preferences), and perceived use of text messages. In phase 2, caregivers participated in a 5-week text message pilot trial that included weekly educational and personalized strategy messages and SSB intake assessments at baseline and follow-up. Before the focus groups and after completing the pilot trial, caregivers also completed a pre-post survey that assessed SSB intake, SSB home availability, and caregivers’ SSB-related practices. Caregivers also completed individual follow-up telephone interviews following the pilot trial. Results In phase 1, caregivers (N=33) reported that text messages were convenient, accessible, and easy to read. In addition, they preferred messages with empathetic and authoritative tones that provided useful strategies and stayed away from using absolute words (eg, always and never). In the phase 2 pilot trial (N=30), 87% of caregivers completed baseline and 77% completed follow-up assessment, suggesting a high utilization rate. Other ways in which caregivers reported benefiting from the text messages included sharing messages with family members and friends (80%), making mental notes (57%), and looking back at messages as reminders (50%). Caregivers reported significant improvements in home environment, parenting practices, and rulemaking around SSB (P=.003, P=.02, and P=.04, respectively). In addition, the frequency of SSB intake among caregivers and adolescents significantly decreased (P=.003 and P=.005, respectively). Conclusions Spending time in the formative phases of text message development helped understand the unique perspectives and language preferences of the target population. Furthermore, delivering an intervention through text messages has the potential to improve caregiver behaviors and reduce SSB intake among rural caregivers and adolescents. Findings from this study were used to develop a larger bank of text messages, which would be used in a future study, testing the effectiveness of a text message intervention targeting SSB intake–related caregiver behaviors.

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How to make online mood-monitoring in bipolar patients a success? A qualitative exploration of requirements

International Journal of Bipolar Disorders ◽

10.1186/s40345-021-00244-2 ◽

2021 ◽

Vol 9 (1) ◽

Author(s):

B. Geerling ◽

S. M. Kelders ◽

R. W. Kupka ◽

A. W. M. M. Stevens ◽

E. T. Bohlmeijer

Keyword(s):

Early Intervention ◽

Focus Groups ◽

Intervention Strategies ◽

Care Providers ◽

Successful Design ◽

Technical Features ◽

Bipolar Patients ◽

Qualitative Exploration ◽

Monitoring Application

Abstract Background The Life-Chart Method (LCM) is an effective self-management treatment option in bipolar disorder (BD). There is insufficient knowledge about the consumers’ needs and desires for an e-monitoring solution. The first step towards a new mood monitoring application is an extended inventory among consumers and professionals. Methods The aim of the current study was: to identify opinions about online mood monitoring of patients with BD and professionals and to identify preferences on design, technical features and options facilitating optimal use and implementation of online mood monitoring. This study used a qualitative design with focus-groups. Participants were recruited among patients and care providers. Three focus-groups were held with eight consumers and five professionals. Results The focus-group meetings reveal a shared consciousness of the importance of using the Life-Chart Method for online mood monitoring. There is a need for personalization, adjustability, a strict privacy concept, an adjustable graphic report, and a link to early intervention strategies in the design. Due to the fact that this is a qualitative study with a relative small number of participants, so it remains unclear whether the results are fully generalizable. We can’t rule out a selection bias. Conclusions This study demonstrates the importance of involving stakeholders in identifying a smartphone-based mood charting applications’ requirements. Personalization, adjustability, privacy, an adjustable graphic report, and a direct link to early intervention strategies are necessary requirements for a successful design. The results of this value specification are included in the follow-up of this project.

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